10 research outputs found
Towards unambiguous reporting of complications related to deep brain stimulation surgery: A retrospective single-center analysis and systematic review of the literature
<div><p>Background and objective</p><p>To determine rates of adverse events (AEs) related to deep brain stimulation (DBS) surgery or implanted devices from a large series from a single institution. Sound comparisons with the literature require the definition of unambiguous categories, since there is no consensus on the reporting of such AEs.</p><p>Patients and methods</p><p>123 consecutive patients (median age 63 yrs; female 45.5%) treated with DBS in the subthalamic nucleus (78 patients), ventrolateral thalamus (24), internal pallidum (20), and centre médian-parafascicular nucleus (1) were analyzed retrospectively. Both mean and median follow-up time was 4.7 years (578 patient-years). AEs were assessed according to three unambiguous categories: (i) hemorrhages including other intracranial complications because these might lead to neurological deficits or death, (ii) infections and similar AEs necessitating the explantation of hardware components as this results in the interruption of DBS therapy, and (iii) lead revisions for various reasons since this involves an additional intracranial procedure. For a systematic review of the literature AE rates were calculated based on primary data presented in 103 publications. Heterogeneity between studies was assessed with the I<sup>2</sup> statistic and analyzed further by a random effects meta-regression. Publication bias was analyzed with funnel plots.</p><p>Results</p><p>Surgery- or hardware-related AEs (23) affected 18 of 123 patients (14.6%) and resolved without permanent sequelae in all instances. In 2 patients (1.6%), small hemorrhages in the striatum were associated with transient neurological deficits. In 4 patients (3.3%; 0.7% per patient-year) impulse generators were removed due to infection. In 2 patients electrodes were revised (1.6%; 0.3% per patient-year). There was no lead migration or surgical revision because of lead misplacement. Age was not statistically significant different (p>0.05) between patients affected by AEs or not. AE rates did not decline over time and similar incidences were found among all patients (423) implanted with DBS systems at our institution until December 2016. A systematic literature review revealed that exact AE rates could not be determined from many studies, which could not be attributed to study designs. Average rates for intracranial complications were 3.8% among studies (per-study analysis) and 3.4% for pooled analysis of patients from different studies (per-patient analysis). Annual hardware removal rates were 3.6 and 2.4% for per-study and per-patient analysis, respectively, and lead revision rates were 4.1 and 2.6%, respectively. There was significant heterogeneity between studies (I<sup>2</sup> ranged between 77% and 91% for the three categories; p< 0.0001). For hardware removal heterogeneity (I<sup>2</sup> = 87.4%) was reduced by taking study size (p< 0.0001) and publication year (p< 0.01) into account, although a significant degree of heterogeneity remained (I<sup>2</sup> = 80.0%; p< 0.0001). Based on comparisons with health care-related databases there appears to be publication bias with lower rates for hardware-related AEs in published patient cohorts.</p><p>Conclusions</p><p>The proposed categories are suited for an unequivocal assessment of AEs even in a retrospective manner and useful for benchmarking. AE rates in the present cohorts from our institution compare favorable with the literature.</p></div
Percent hardware removal per patient-year.
<p>The rate of AEs is color-coded. The number of patient-years calculated for individual studies is indicated by the height of the wedges (cutoff value 1000 patient-years).</p
Summary of literature-based rates for adverse events related to DBS surgery and implanted hardware.
<p>Summary of literature-based rates for adverse events related to DBS surgery and implanted hardware.</p
Percent intracranial AEs per patient.
<p>The rate of AEs is color-coded. The number of patients that have been included in respective studies are indicated by the height of the wedges (cutoff value 500 patients).</p
Systematic review of the literature based on a triad of categories.
<p>Systematic review of the literature based on a triad of categories.</p
Evaluation of study quality based on questions from common check lists.
<p>Evaluation of study quality based on questions from common check lists.</p
Intracerebral hemorrhages in the striatum along implanted electrodes (arrows) as detected in CT scans obtained on postoperative day three (A and B, patient#1; STN stimulation; diameter 1.2 cm) and day one (C and D, patient#2; GPI stimulation; diameter < 1 cm).
<p>Intracerebral hemorrhages in the striatum along implanted electrodes (arrows) as detected in CT scans obtained on postoperative day three (A and B, patient#1; STN stimulation; diameter 1.2 cm) and day one (C and D, patient#2; GPI stimulation; diameter < 1 cm).</p
Percent lead revision per patient-year.
<p>The rate of AEs is color-coded. The number of patient-years calculated for individual studies is indicated by the height of the wedges (cutoff value 1000 patient-years).</p
Categories for the assessment of adverse events related to DBS surgery and implanted hardware.
<p>Categories for the assessment of adverse events related to DBS surgery and implanted hardware.</p