Complication rates, lengths of stay, and readmission rates in “awake” and “asleep” deep brain simulation

Abstract

OBJECTIVE As the number of deep brain stimulation (DBS) procedures performed under general anesthesia ("asleep" DBS) increases, it is more important to assess the rates of adverse events, inpatient lengths of stay (LOS), and 30-day readmission rates in patients undergoing these procedures compared with those in patients undergoing traditional "awake" DBS without general anesthesia. METHODS All patients in an institutional database who had undergone awake or asleep DBS procedures performed by a single surgeon between August 2011 and August 2014 were reviewed. Adverse events, inpatient LOS, and 30-day readmissions were analyzed. RESULTS A total of 490 electrodes were placed in 284 patients, of whom 126 (44.4%) underwent awake surgery and 158 (55.6%) underwent asleep surgery. The most frequent overall complication for the cohort was postoperative mental status change (13 patients [4.6%]), followed by hemorrhage (4 patients [1.4%]), seizure (4 patients [1.4%]), and hardware-related infection (3 patients [1.1%]). Mean LOS for all 284 patients was 1.19 ± 1.29 days (awake: 1.06 ± 0.46 days; asleep: 1.30 ± 1.67 days; p = 0.08). Overall, the 30-day readmission rate was 1.4% (1 awake patient, 3 asleep patients). There were no significant differences in complications, LOS, and 30-day readmissions between awake and asleep groups. CONCLUSIONS Both awake and asleep DBS can be performed safely with low complication rates. The authors found no significant differences between the 2 procedure groups in adverse events, inpatient LOS, and 30-day readmission rates.

Comparison of Awake and Asleep Deep Brain Stimulation for Parkinson’s Disease: A Detailed Analysis Through Literature Review

“…Specifically, the study summarized 284 DBS patients with 490 intracranial electrodes implanted, including 126 awake DBS patients and 158 asleep DBS patients. The complication rates of awake vs. asleep DBS operations are as follows: psychiatric symptoms 3.6% vs. 5.8%, bleeding 1.5% vs. 1.4%, epilepsy 2.0% vs. 0.7%, infection 1.0% vs. 1.4%, erosion 0.5% vs. 0%, high circuit impedance 0.5% vs. 0.7%, electrode displacement 0% vs. 1.4% . Statistical analysis showed that there was no difference in the incidence of the above complications between awake and asleep cohorts.…”

“…However, it should be noted that the above conclusions were not drawing from a direct comparison between awake and asleep DBS surgeries, which may have some biases. In particular, a recent study systematically summarized the incidences of the complications, hospitalization times, and readmission rates of patients who underwent awake and asleep DBS surgeries . Specifically, the study summarized 284 DBS patients with 490 intracranial electrodes implanted, including 126 awake DBS patients and 158 asleep DBS patients.…”

The role of deep brain stimulation in Parkinson’s disease: an overview and update on new developments

“…In a recent representative study by Chen et al, the rate of cerebral hemorrhage was 1.4% and the rate of hardware infection was 1.1%. Postoperative mental status change occurred in 4.6%, and seizure occurred in 1.4% 64. In contrast, a study by Doshi in 2011 with a longer mean duration of follow-up showed confusion in 3.9%, hardware infection in 4.5%, and malfunction of the implantable pulse generator (IPG) in 1.4% 65.…”

“…Among others, major concerns would include intracranial bleeding, seizure, stroke, hardware malfunction, infection, prolonged length of hospitalization, and postoperative confusion. The rate of postoperative complications is related both to the length of postoperative follow-up and the intensity of invest igation 9,14,19,20,55,64–66. In a recent representative study by Chen et al, the rate of cerebral hemorrhage was 1.4% and the rate of hardware infection was 1.1%.…”

State of the Art: Novel Applications for Cortical Stimulation

“…In a stroke study treated with MCS, one patient developed two seizures . Thus, the risk of seizures seems to be acceptable and in the range of DBS (1.4%) .…”