Deep Brain Stimulation Generator Replacement in End-Stage Parkinson Disease.

BACKGROUND: The decision to replace deep brain stimulation (DBS) generators in end-stage Parkinson disease (PD) is based on the patients' clinical status and the risks of this surgery. The infection rates of initial DBS implantation surgery and generator replacement surgery are well established. But the risks of DBS generator replacement for the severely disabled end-stage PD patient have not been described. METHODS: A retrospective analysis of all DBS procedures (n = 446) for PD spanning 20 years in a single institution was performed. The focus was on generator replacement procedure performed in end-stage PD. Infections related to DBS surgery were evaluated. RESULTS: Perioperative infections (<90 days) after generator replacements occurred in 0.6% of 172 cases and 2.5% of 232 primary lead implantation. Delayed infections (>90 days) occurred in 2.7% of all cases. Generator replacement was performed in 11 end-stage PD patients. None of these patients developed perioperative or delayed infections, and none were readmitted for medical or surgical complications. CONCLUSIONS: DBS generator replacement surgery is low risk, even in patients who have end-stage PD.

Pre-operative smoking history increases risk of infection in deep brain stimulation surgery.

Although general risk of deep brain stimulation (DBS) therapy has been previously described, application of risk prediction at the individual patient level is still largely at the discretion of a treating physician or a multidisciplinary team. To explore associations between potentially modifiable patient characteristics and common adverse events following DBS surgery, we retrospectively reviewed consecutive adult patients who had undergone new DBS electrode placement surgeries at two high-volume tertiary referral centers between October 1997 and May 2018. Among 501 patients included in the analysis (mean age (SD), 64.6 (10.4) years), 165 (32.9%) were female, 67 (13.4%) had diabetes, 231 (46.1%) had hypertension, 25 (5.0%) were smokers, 27 (5.4%) developed an infection, 15 (3.0%) had intracranial or intraventricular hemorrhage, and 53 (10.6%) had an unplanned return to the operating room. Patients who developed a surgical site infection were more likely to report history of smoking before DBS surgery (16% vs 5%, p = 0.04). There was a trend for patients with hypertension to be at risk for intracranial hemorrhage (p = 0.11). In conclusion, this multicenter study demonstrated an association between preoperative smoking and increased risk of infection following new DBS implantation surgery. Counseling about this risk should be considered in preoperative evaluation of patients who are considering undergoing a DBS procedure.