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Published on: August 12, 2018
Trends in Deep Brain Stimulation Surgery in the United States
Derrick Chatad1,2, Michael Melhem3, Abigail Abraham Teshome4
1Brown University Health, Providence, Rhode Island, USA.
Introduction:
Deep brain stimulation (DBS) procedures vary by use of microelectrode recording (MER) and by unilateral or bilateral implantation. Our goal was to quantify national, regional, and state-level trends in total procedures, MER utilization, and unilateral vs. bilateral electrode implantation.
Methods:
The Centers for Medicare and Medicaid Services database was queried for patients undergoing DBS procedures from 2013 to 2023 yielding 27,846 total patients. Use of MER, unilateral vs. bilateral DBS electrode implantation, and procedure location were extracted. Data were analyzed using Shapiro-Wilk test, Pearson's Correlation Coefficient, Spearman's Correlation Coefficient, ANOVA or Kruskal-Wallis with post hoc testing, and Benjamini-Hochberg correction.
Results:
From 2013 to 2023, total DBS electrode implantation procedures did not change significantly. MER+ DBS was more common than MER- DBS across all years, although MER- DBS increased over time (r = 0.94) while MER+ DBS decreased over time (r = -0.75). Bilateral DBS increased (r = 0.86) over time and in 2021 became more common than unilateral DBS, which decreased over time (r = -0.73). Unilateral and bilateral MER- DBS increased (r = 0.84, 0.95), while unilateral MER+ DBS decreased (r = -0.97). All regions had an increase in MER- DBS (r = 0.96, 0.81, 0.94, 0.84, respectively). The West performed the most MER- DBS, while the South performed the most MER+ DBS. The Midwest and West had an increase in percentage of bilateral DBS (r = 0.95, 0.90, respectively). Regional changes favoring MER- DBS and bilateral electrode implantation were noticed in many states. All reported significant outcomes had p < 0.05.
Conclusion:
Nationally, there is a trend towards performing bilateral and MER- DBS. Recently, there are more bilateral than unilateral procedures, but MER+ is still more common than MER-. Regional differences in DBS surgery also exist. These findings have implications for the experience of patients, neurosurgical trainees, and institutions across the USA.
