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Trends and disparities in deep brain stimulation utilization in the United States: a Nationwide Inpatient Sample analysis from 1993 to 2017.
Sarica, Can; Conner, Christopher R; Yamamoto, Kazuaki; Yang, Andrew; Germann, Jürgen; Lannon, Melissa M; Samuel, Nardin; Colditz, Michael; Santyr, Brendan; Chow, Clement T; Iorio-Morin, Christian; Aguirre-Padilla, David H; Lang, Stefan Thomas; Vetkas, Artur; Cheyuo, Cletus; Loh, Aaron; Darmani, Ghazaleh; Flouty, Oliver; Milano, Vanessa; Paff, Michelle; Hodaie, Mojgan; Kalia, Suneil K; Munhoz, Renato P; Fasano, Alfonso; Lozano, Andres M.
Afiliación
  • Sarica C; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
  • Conner CR; Krembil Research Institute, University Health Network, Toronto, ON, Canada.
  • Yamamoto K; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
  • Yang A; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
  • Germann J; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
  • Lannon MM; Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
  • Samuel N; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
  • Colditz M; Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
  • Santyr B; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
  • Chow CT; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
  • Iorio-Morin C; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
  • Aguirre-Padilla DH; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
  • Lang ST; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
  • Vetkas A; Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, QC, Canada.
  • Cheyuo C; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
  • Loh A; Department of Neurosurgery, Medical School, Universidad de Chile, Santiago, Chile.
  • Darmani G; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
  • Flouty O; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
  • Milano V; Department of Neurosurgery, Tartu University Hospital, University of Tartu, Tartu, Estonia.
  • Paff M; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
  • Hodaie M; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
  • Kalia SK; Krembil Research Institute, University Health Network, Toronto, ON, Canada.
  • Munhoz RP; Department of Neurosurgery, University of South Florida, Tampa, FL, United States.
  • Fasano A; Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ, United States.
  • Lozano AM; Department of Neurosurgery, University of California Irvine, Orange, CA, United States.
Lancet Reg Health Am ; 26: 100599, 2023 Oct.
Article en En | MEDLINE | ID: mdl-37876670
ABSTRACT

Background:

Deep brain stimulation (DBS) is an approved treatment option for Parkinson's Disease (PD), essential tremor (ET), dystonia, obsessive-compulsive disorder and epilepsy in the United States. There are disparities in access to DBS, and clear understanding of the contextual factors driving them is important. Previous studies aimed at understanding these factors have been limited by single indications or small cohort sizes. The aim of this study is to provide an updated and comprehensive analysis of DBS utilization for multiple indications to better understand the factors driving disparities in access.

Methods:

The United States based National Inpatient Sample (NIS) database was utilized to analyze the surgical volume and trends of procedures based on indication, using relevant ICD codes. Predictors of DBS use were analyzed using a logistic regression model. DBS-implanted patients in each indication were compared based on the patient-, hospital-, and outcome-related variables.

Findings:

Our analysis of 104,356 DBS discharges from 1993 to 2017 revealed that the most frequent indications for DBS were PD (67%), ET (24%), and dystonia (4%). Although the number of DBS procedures has consistently increased over the years, radiofrequency ablation utilization has significantly decreased to only a few patients per year since 2003. Negative predictors for DBS utilization in PD and ET cohorts included age increase and female sex, while African American status was a negative predictor across all cohorts. Significant differences in patient-, hospital-, and outcome-related variables between DBS indications were also determined.

Interpretation:

Demographic and socioeconomic-based disparities in DBS use are evident. Although racial disparities are present across all indications, other disparities such as age, sex, wealth, and insurance status are only relevant in certain indications.

Funding:

This work was supported by Alan & Susan Hudson Cornerstone Chair in Neurosurgery at University Health Network.
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Texto completo: 1 Bases de datos: MEDLINE Idioma: En Revista: Lancet Reg Health Am Año: 2023 Tipo del documento: Article País de afiliación: Canadá
Texto completo
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Bases de datos: MEDLINE Idioma: En Revista: Lancet Reg Health Am Año: 2023 Tipo del documento: Article País de afiliación: Canadá