Reduced Risk of Reoperations With Modern Deep Brain Stimulator Systems: Big Data Analysis From a United States Claims Database

Objective: There have been significant improvements in the design and manufacturing of deep brain stimulation (DBS) systems, but no study has considered the impact of modern systems on complications. We sought to compare the relative occurrence of reoperations after de novo implantation of modern an...

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Autores principales:	Chengyuan Wu, Sean J. Nagel, Rahul Agarwal, Monika Pötter-Nerger, Wolfgang Hamel, Ashwini D. Sharan, Allison T. Connolly, Binith Cheeran, Paul S. Larson
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	deep brain stimulation Parkinson's disease essential tremor Medicare big data & analytics neurosurgery Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/551150811a1947bd8086fdefcddaf82a
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spelling	oai:doaj.org-article:551150811a1947bd8086fdefcddaf82a2021-12-02T14:16:54ZReduced Risk of Reoperations With Modern Deep Brain Stimulator Systems: Big Data Analysis From a United States Claims Database1664-229510.3389/fneur.2021.785280https://doaj.org/article/551150811a1947bd8086fdefcddaf82a2021-12-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fneur.2021.785280/fullhttps://doaj.org/toc/1664-2295Objective: There have been significant improvements in the design and manufacturing of deep brain stimulation (DBS) systems, but no study has considered the impact of modern systems on complications. We sought to compare the relative occurrence of reoperations after de novo implantation of modern and traditional DBS systems in patients with Parkinson's disease (PD) or essential tremor (ET) in the United States.Design: Retrospective, contemporaneous cohort study.Setting: Multicenter data from the United States Centers for Medicare and Medicaid Services administrative claims database between 2016 and 2018.Participants: This population-based sample consisted of 5,998 patients implanted with a DBS system, of which 3,869 patients had a de novo implant and primary diagnosis of PD or ET. Follow-up of 3 months was available for 3,810 patients, 12 months for 3,561 patients, and 24 months for 1,812 patients.Intervention: Implantation of a modern directional (MD) or traditional omnidirectional (TO) DBS system.Primary and Secondary Outcome Measures: We hypothesized that MD systems would impact complication rates. Reoperation rate was the primary outcome. Associated diagnoses, patient characteristics, and implanting center details served as covariates. Kaplan–Meier analysis was performed to compare rates of event-free survival and regression models were used to determine covariate influences.Results: Patients implanted with modern systems were 36% less likely to require reoperation, largely due to differences in acute reoperations and intracranial lead reoperations. Risk reduction persisted while accounting for practice differences and implanting center experience. Risk reduction was more pronounced in patients with PD.Conclusions: In the first multicenter analysis of device-related complications including modern DBS systems, we found that modern systems are associated with lower reoperation rates. This risk profile should be carefully considered during device selection for patients undergoing DBS for PD or ET. Prospective studies are needed to further investigate underlying causes.Chengyuan WuSean J. NagelRahul AgarwalMonika Pötter-NergerWolfgang HamelAshwini D. SharanAllison T. ConnollyBinith CheeranPaul S. LarsonFrontiers Media S.A.articledeep brain stimulationParkinson's diseaseessential tremorMedicarebig data & analyticsneurosurgeryNeurology. Diseases of the nervous systemRC346-429ENFrontiers in Neurology, Vol 12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	deep brain stimulation Parkinson's disease essential tremor Medicare big data & analytics neurosurgery Neurology. Diseases of the nervous system RC346-429
spellingShingle	deep brain stimulation Parkinson's disease essential tremor Medicare big data & analytics neurosurgery Neurology. Diseases of the nervous system RC346-429 Chengyuan Wu Sean J. Nagel Rahul Agarwal Monika Pötter-Nerger Wolfgang Hamel Ashwini D. Sharan Allison T. Connolly Binith Cheeran Paul S. Larson Reduced Risk of Reoperations With Modern Deep Brain Stimulator Systems: Big Data Analysis From a United States Claims Database
description	Objective: There have been significant improvements in the design and manufacturing of deep brain stimulation (DBS) systems, but no study has considered the impact of modern systems on complications. We sought to compare the relative occurrence of reoperations after de novo implantation of modern and traditional DBS systems in patients with Parkinson's disease (PD) or essential tremor (ET) in the United States.Design: Retrospective, contemporaneous cohort study.Setting: Multicenter data from the United States Centers for Medicare and Medicaid Services administrative claims database between 2016 and 2018.Participants: This population-based sample consisted of 5,998 patients implanted with a DBS system, of which 3,869 patients had a de novo implant and primary diagnosis of PD or ET. Follow-up of 3 months was available for 3,810 patients, 12 months for 3,561 patients, and 24 months for 1,812 patients.Intervention: Implantation of a modern directional (MD) or traditional omnidirectional (TO) DBS system.Primary and Secondary Outcome Measures: We hypothesized that MD systems would impact complication rates. Reoperation rate was the primary outcome. Associated diagnoses, patient characteristics, and implanting center details served as covariates. Kaplan–Meier analysis was performed to compare rates of event-free survival and regression models were used to determine covariate influences.Results: Patients implanted with modern systems were 36% less likely to require reoperation, largely due to differences in acute reoperations and intracranial lead reoperations. Risk reduction persisted while accounting for practice differences and implanting center experience. Risk reduction was more pronounced in patients with PD.Conclusions: In the first multicenter analysis of device-related complications including modern DBS systems, we found that modern systems are associated with lower reoperation rates. This risk profile should be carefully considered during device selection for patients undergoing DBS for PD or ET. Prospective studies are needed to further investigate underlying causes.
format	article
author	Chengyuan Wu Sean J. Nagel Rahul Agarwal Monika Pötter-Nerger Wolfgang Hamel Ashwini D. Sharan Allison T. Connolly Binith Cheeran Paul S. Larson
author_facet	Chengyuan Wu Sean J. Nagel Rahul Agarwal Monika Pötter-Nerger Wolfgang Hamel Ashwini D. Sharan Allison T. Connolly Binith Cheeran Paul S. Larson
author_sort	Chengyuan Wu
title	Reduced Risk of Reoperations With Modern Deep Brain Stimulator Systems: Big Data Analysis From a United States Claims Database
title_short	Reduced Risk of Reoperations With Modern Deep Brain Stimulator Systems: Big Data Analysis From a United States Claims Database
title_full	Reduced Risk of Reoperations With Modern Deep Brain Stimulator Systems: Big Data Analysis From a United States Claims Database
title_fullStr	Reduced Risk of Reoperations With Modern Deep Brain Stimulator Systems: Big Data Analysis From a United States Claims Database
title_full_unstemmed	Reduced Risk of Reoperations With Modern Deep Brain Stimulator Systems: Big Data Analysis From a United States Claims Database
title_sort	reduced risk of reoperations with modern deep brain stimulator systems: big data analysis from a united states claims database
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/551150811a1947bd8086fdefcddaf82a
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Reduced Risk of Reoperations With Modern Deep Brain Stimulator Systems: Big Data Analysis From a United States Claims Database

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