Early work on deep brain stimulation (DBS) surgery, when procedures were mostly carried out in a small number of high-volume centers, demonstrated a relationship between surgical volume and procedural safety. However, over the past decade, DBS has become more widely available in the community rather than solely at academic medical centers. The authors examined the Nationwide Inpatient Sample (NIS) to study the safety of DBS surgery for Parkinson disease (PD) in association with this change in practice patterns.
The NIS is a stratified sample of 20% of all patient discharges from nonfederal hospitals in the United States. The authors identified patients with a primary diagnosis of PD (332.0) and a primary procedure code for implantation/replacement of intracranial neurostimulator leads (02.93) who underwent surgery between 2002 and 2009. They analyzed outcomes using univariate and hierarchical, logistic regression analyses.
The total number of DBS cases remained stable from 2002 through 2009. Despite older and sicker patients undergoing DBS, procedural safety (rates of non-home discharges, complications) remained stable. Patients at low-volume hospitals were virtually indistinguishable from those at high-volume hospitals, except that patients at low-volume hospitals had slightly higher comorbidity scores (0.90 vs 0.75, p < 0.01). Complications, non-home discharges, length of hospital stay, and mortality rates did not significantly differ between low- and high-volume hospitals when accounting for hospital-related variables (caseload, teaching status, location).
Prior investigations have demonstrated a robust volume-outcome relationship for a variety of surgical procedures. However, the present study supports safety of DBS at smaller-volume centers. Prospective studies are required to determine whether low-volume centers and higher-volume centers have similar DBS efficacy, a critical factor in determining whether DBS is comparable between centers.
Abbreviations used in this paper:CI = confidence interval; DBS = deep brain stimulation; HCUP = Healthcare Cost and Utilization Project; ICD-9 = International Classification of Diseases, 9th edition; LOS = length of stay; NIS = Nationwide Inpatient Sample; OR = odds ratio; PD = Parkinson disease.
Address correspondence to: Robert A. McGovern, M.D., Department of Neurological Surgery, Neurological Institute, Columbia University Medical Center, 710 West 168th St., New York, NY 10032. email: firstname.lastname@example.org.
Please include this information when citing this paper: published online September 27, 2013; DOI: 10.3171/2013.8.JNS13475.
BarkerFGIIAmin-HanjaniSButlerWEOgilvyCSCarterBS: In-hospital mortality and morbidity after surgical treatment of unruptured intracranial aneurysms in the United States, 1996–2000: the effect of hospital and surgeon volume. Neurosurgery52:995–10092003
BarkerFGIIKlibanskiASwearingenB: Transsphenoidal surgery for pituitary tumors in the United States, 1996–2000: mortality, morbidity, and the effects of hospital and surgeon volume. J Clin Endocrinol Metab88:4709–47192003
ChernovMF: The impact of provider volume on mortality after intracranial tumor resection and outcome and cost of craniotomy performed to treat tumors in regional academic referral centers. Neurosurgery54:1027–10282004. (Letter)
CowanJAJrDimickJBThompsonBGStanleyJCUpchurchGRJr: Surgeon volume as an indicator of outcomes after carotid endarterectomy: an effect independent of specialty practice and hospital volume. J Am Coll Surg195:814–8212002
EskandarENFlahertyACosgroveGRShinobuLABarkerFGII: Surgery for Parkinson disease in the United States, 1996 to 2000: practice patterns, short-term outcomes, and hospital charges in a nationwide sample. J Neurosurg99:863–8712003
GologorskyYBen-HaimSMoshierELGodboldJTagliatiMWeiszD: Transgressing the ventricular wall during subthalamic deep brain stimulation surgery for Parkinson disease increases the risk of adverse neurological sequelae. Neurosurgery69:294–3002011
HohBLRabinovJDPryorJCCarterBSBarkerFGII: Inhospital morbidity and mortality after endovascular treatment of unruptured intracranial aneurysms in the United States, 1996–2000: effect of hospital and physician volume. AJNR Am J Neuroradiol24:1409–14202003
HoltPJPolonieckiJDLoftusIMThompsonMM: Metaanalysis and systematic review of the relationship between hospital volume and outcome following carotid endarterectomy. Eur J Vasc Endovasc Surg33:645–6512007
PierotLSpelleLVitryF: Similar safety in centers with low and high volumes of endovascular treatments for unruptured intracranial aneurysms: evaluation of the analysis of treatment by endovascular approach of nonruptured aneurysms study. AJNR Am J Neuroradiol31:1010–10142010
SmithERButlerWEBarkerFGII: Craniotomy for resection of pediatric brain tumors in the United States, 1988 to 2000: effects of provider caseloads and progressive centralization and specialization of care. Neurosurgery54:553–5652004
TaylorCLYuanZSelmanWRRatchesonRARimmAA: Mortality rates, hospital length of stay, and the cost of treating subarachnoid hemorrhage in older patients: institutional and geographical differences. J Neurosurg86:583–5881997