Objective: Although general risk of deep brain stimulation (DBS) therapy has been previously described, application of risk prediction at the individual patient level is still largely at the discretion of a treating physician or a multidisciplinary team. The objective of this study was to explore associations between modifiable patient characteristics and common adverse events following DBS surgery.

Background: Since the introduction of deep brain stimulation surgery (DBS) for the treatment of movement disorders by Benabid and colleagues in 1987 [1], there has been a substantial worldwide increase in utilization of this therapy. For DBS, studies have found that history of hypertension and increasing age were associated with intracranial hemorrhage in DBS surgery [2] with readmission after DBS surgery being associated with preoperative coronary artery disease, obesity, and history of smoking [3]. The types of risks of DBS therapy have been well established, but the rates of adverse events are highly variable in the literature and are typically reported as single-surgeon experiences [4-7].

Method: A retrospective cohort study of consecutive adult patients undergoing new DBS electrode placement surgeries between October 1997 and May 2018. Administrative and quality improvement databases at two high-volume tertiary referral centers were used to identify patients meeting inclusion criteria and to collect demographic and clinically relevant variables for exploratory and confirmatory analysis.

Results: Among 501 patients included in the analysis (mean age (SD), 64.6 (10.4) years), 165 (32.9%) were female, 67 (13.4%) had diabetes, 231 (46.1%) had hypertension, 25 (5.0%) were smokers, 27 (5.4%) developed an infection, 15 (3.0%) had intracranial or intraventricular hemorrhage, and 53 (10.6%) had an unplanned return to the operating room [table1]. Patients who developed a surgical site infection were more likely to report history of smoking before DBS surgery (16% vs 5%, p = 0.04). There was a trend for patients with hypertension to be at risk for intracranial hemorrhage (p = 0.11) [table2].

Conclusion: This multicenter study demonstrated an association between preoperative smoking and increased risk of infection following new DBS implantation surgery. Counseling about this risk should be considered in pre-operative evaluation of patients who are considering undergoing a DBS procedure.

References: [1] Benabid A-L, Pollak P, Louveau A, Henry S, De Rougemont J. Combined (thalamotomy and stimulation) stereotactic surgery of the VIM thalamic nucleus for bilateral Parkinson disease. Stereotactic and functional neurosurgery. 1987;50(1-6):344-6. [2] Zrinzo L, Foltynie T, Limousin P, Hariz MI. Reducing hemorrhagic complications in functional neurosurgery: a large case series and systematic literature review. Journal of neurosurgery. 2012;116(1):84-94. [3] Rumalla K, Smith KA, Follett K, Nazzaro J, Arnold PM. Rates, Causes, Risk Factors, and Outcomes of Readmission Following Deep Brain Stimulation for Movement Disorders: Analysis of the US Nationwide Readmissions Database. Clinical neurology and neurosurgery. 2018. [4] Fenoy AJ, Simpson Jr RK. Risks of common complications in deep brain stimulation surgery: management and avoidance. Journal of neurosurgery. 2014;120(1):132-9. [5] Falowski SM, Ooi YC, Bakay RA. Long‐term evaluation of changes in operative technique and hardware‐related complications with deep brain stimulation. Neuromodulation: Technology at the Neural Interface. 2015;18(8):670-7. [6] Hardaway FA, Raslan AM, Burchiel KJ. Deep Brain Stimulation-Related Infections: Analysis of Rates, Timing, and Seasonality. Neurosurgery. 2018;83(3):540-7. Epub 2017/10/20. doi: 10.1093/neuros/nyx505. PubMed PMID: 29048556. [7] Bjerknes S, Skogseid IM, Sæhle T, Dietrichs E, Toft M. Surgical site infections after deep brain stimulation surgery: frequency, characteristics and management in a 10-year period. PLoS One. 2014;9(8):e105288.

« Back to 2019 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/preoperative-smoking-history-increases-risk-of-infection-in-deep-brain-stimulation-surgery/