Objective: To determine risk factors for infection in a single-center retrospective sample of patients who underwent deep brain stimulation.

Background: Deep brain stimulation (DBS) is a widely utilized therapeutic intervention for medication-refractory movement disorders including Parkinson’s disease, Essential Tremor, and Dystonia. Although procedural complication rates are below 3-5% (1), hardware infection remains a concerning adverse event as it can lead to treatment delays, increase healthcare costs, and necessitate device explantation. Understanding the underlying risk factors for infection is crucial to optimizing DBS outcomes. We hypothesized that patient-specific, disease-specific, and surgical factors would influence infection risk.

Method: A single center retrospective cohort study was conducted of patients who underwent DBS from 2012 to 2024. Hardware infection counts were noted from the records. A univariate analysis was performed to assess the influence of individual risk factors; a time-to-event (survival) analysis was also conducted to assess the predictive value of selected covariates, unadjusted and adjusted for age and sex.

Results: Eighty-three patients underwent DBS with follow up over twelve years were included in the analysis (mean age 63 ± 12 years). Hardware infections occurred in twelve patients (14.46%). Significant risk factors for hardware infection included diabetes (p-value <0.01), coronary artery disease (CAD) (p-value 0.03) and congestive heart failure (CHF) (p-value 0.03), physical disability (defined as needing a walker to ambulate) (p-value 0.02), and longer duration of disease prior to surgery (p-value 0.02). Notably, BMI was not associated with higher risk of infection (p-value 0.13). In the survival analysis (controlling for baseline MDS-UPDRS-III scores, illness duration, and change in post-operative levodopa administration), diabetes was significantly associated with time-to-infection (Hazard-ratio 3.88, p-value 0.02) although this finding was not significant after controlling for age and sex.

Conclusion: This study identified significant risk factors for developing DBS hardware infections including medical comorbidities (diabetes, CAD, and CHF), physical disability, and longer disease duration prior to surgery. Presence of diabetes is a particularly strong-risk factor in unadjusted survival analysis. These findings inform both DBS patient selection and counselling following DBS.

References: 1. Deep-Brain Stimulation for Parkinson’s Disease Study Group, Obeso JA, Olanow CW, et al. Deep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson’s disease. N Engl J Med. 2001;345(13):956-963. doi:10.1056/NEJMoa000827

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MDS Abstracts - https://www.mdsabstracts.org/abstract/risk-factors-for-dbs-hardware-infections/