Session Time: 1:15pm-2:45pm
Location: Les Muses Terrace, Level 3
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 , 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  with readmission after DBS surgery being associated with preoperative coronary artery disease, obesity, and history of smoking . 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:  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.  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.  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.  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.  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.  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.  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.
To cite this abstract in AMA style:M. Sikora, F. Farrokhi, M. Marsans, S. Monsell, A. Wright, M. Palmer, A. Hoefer, P. Mcleod, J. Mark, J. Carlson. Preoperative Smoking History Increases Risk of Infection in Deep Brain Stimulation Surgery [abstract]. Mov Disord. 2019; 34 (suppl 2). https://www.mdsabstracts.org/abstract/preoperative-smoking-history-increases-risk-of-infection-in-deep-brain-stimulation-surgery/. Accessed December 5, 2023.
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MDS Abstracts - https://www.mdsabstracts.org/abstract/preoperative-smoking-history-increases-risk-of-infection-in-deep-brain-stimulation-surgery/