Morbidity, mortality, facility placement and cost of deep brain stimulation for Parkinson's disease

Deep brain stimulation (DBS) is an established therapy for advanced Parkinson's disease (PD), but its long-term social and clinical impact has not been well characterized in large cohorts. We conducted a retrospective cohort study using a nationwide hospital database across the United States. Among 79,845 adults hospitalized with PD in 2018 and followed through 2023, 482 underwent DBS implantation. Overlap propensity score weighting was used to balance baseline characteristics. Weighted logistic and gamma regression models estimated adjusted odds ratios (aORs) and cost ratios at 1, 3, and 5 years after discharge. DBS was associated with significantly lower risks of institutionalization at 1, 3, and 5 years (aORs 0.25-0.27) and lower mortality at 1 and 5 years (aORs 0.09 and 0.27). Total healthcare expenditures were also lower in the DBS group (cost ratios 0.68-0.73). Readmission rates were similar between groups but tended to decline over time among DBS recipients. Sensitivity analyses excluding patients with dementia and restricting to non-emergency admissions yielded consistent results. Although DBS implantations were concentrated in large, urban teaching hospitals, outcomes were comparable between teaching and non-teaching institutions. These findings suggest sustained clinical and economic benefits of DBS and highlight the importance of improving equitable access.