Trends in Deep Brain Stimulation Surgery in the United States

Area of Science:

• Neurosurgery
• Neurology
• Medical Device Technology

Background:

• Deep brain stimulation (DBS) procedures exhibit variability in microelectrode recording (MER) use and implantation laterality (unilateral vs. bilateral).
• Understanding national and regional trends in DBS is crucial for patient care and surgical training.

Purpose of the Study:

• To quantify national, regional, and state-level trends in total DBS procedures.
• To analyze trends in microelectrode recording (MER) utilization during DBS surgery.
• To assess changes in unilateral versus bilateral electrode implantation in DBS procedures.

Main Methods:

• Analysis of the Centers for Medicare and Medicaid Services database from 2013-2023, including 27,846 DBS patients.
• Extraction of data on MER use, unilateral/bilateral implantation, and procedure location.
• Statistical analysis using Shapiro-Wilk test, correlation coefficients, ANOVA/Kruskal Wallis, and Benjamini-Hochberg correction.

Main Results:

• Total DBS procedures remained stable, but MER-negative DBS increased (r=0.94) while MER-positive DBS decreased (r=-0.75).
• Bilateral DBS increased significantly (r=0.86), surpassing unilateral procedures by 2021.
• Regional analysis revealed increased MER-negative DBS across all regions, with the West leading in MER-negative and the South in MER-positive procedures.

Conclusions:

• A national trend towards bilateral and MER-negative DBS procedures is evident.
• While bilateral procedures now exceed unilateral, MER-positive DBS remains more common than MER-negative.
• Significant regional disparities in DBS surgical approaches highlight the need for tailored strategies.