Rates, causes, risk factors, and outcomes of readmission following deep brain stimulation for movement disorders: Analysis of the U.S. Nationwide Readmissions Database

Kavelin Rumalla, Kyle A. Smith, Kenneth A Follett, Jules M. Nazzaro, Paul M. Arnold

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: Deep brain stimulation (DBS) surgery has proven benefit for several movement disorders and medically-refractory psychiatric conditions and is considered a fairly safe procedure. We sought to determine the national rates, causes, predictors, and outcomes associated with 30-day and 90-day readmission. Patients and Methods: The Nationwide Readmissions Database was queried (January-September 2013) using ICD-9-CM codes, identifying patients who underwent DBS for movement disorder (Parkinson's disease [PD], essential tremor [ET], or dystonia). Variables included categorical age, gender, insurance, comorbidities, type of movement disorder, length of stay (LOS), total costs, and discharge disposition. Results: A total of 3392 DBS patients were identified [PD (70.7%), ET (25.6%), dystonia (3.7%)]. The mean age was 64.8 ± 0.4 years old and 37% were female. The rates of unplanned readmissions was 1.9% at 30-days and 4.3% at 90 days. The overall NRD incidence (all patient populations) of 30-day readmission is 11.6%. Readmissions most frequently resulted from surgical complications including hematoma and attention to surgical wounds. Elderly, obese, and those with comorbidities such as history of stroke or CAD are at highest risk. The average LOS, mean total cost, and rate of adverse discharge were worse for 30-day (9 days, $64,520, 71.7%) compared to 90-day readmission (6 days, $52,183, 56.5%). Conclusion: All-cause, unplanned readmission for DBS was 1.9% within 30-days and 4.3% within 90-days. Risk factors for readmission in our study, such as advanced age and multiple medical comorbidities, are not unique to DBS. Unplanned readmissions are much rarer following DBS compared to most hospital discharges but can occasionally lead to additional costs and rare complications including hematoma, stroke, and wound infection. DBS should continue to be viewed as a safe and effective treatment modality for a wide range of neurological ailments.

Original languageEnglish (US)
Pages (from-to)129-134
Number of pages6
JournalClinical Neurology and Neurosurgery
Volume171
DOIs
StatePublished - Aug 2018

Fingerprint

Deep Brain Stimulation
Movement Disorders
Databases
Essential Tremor
Comorbidity
Dystonia
Costs and Cost Analysis
Hematoma
Parkinson Disease
Length of Stay
Stroke
International Classification of Diseases
Wound Infection
Insurance
Psychiatry
Incidence
Population

Keywords

  • Deep brain stimulation
  • Movement disorders
  • Readmissions

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Rates, causes, risk factors, and outcomes of readmission following deep brain stimulation for movement disorders : Analysis of the U.S. Nationwide Readmissions Database. / Rumalla, Kavelin; Smith, Kyle A.; Follett, Kenneth A; Nazzaro, Jules M.; Arnold, Paul M.

In: Clinical Neurology and Neurosurgery, Vol. 171, 08.2018, p. 129-134.

Research output: Contribution to journalArticle

@article{74c82b907e4a4f048d6f8ac47b746984,
title = "Rates, causes, risk factors, and outcomes of readmission following deep brain stimulation for movement disorders: Analysis of the U.S. Nationwide Readmissions Database",
abstract = "Objective: Deep brain stimulation (DBS) surgery has proven benefit for several movement disorders and medically-refractory psychiatric conditions and is considered a fairly safe procedure. We sought to determine the national rates, causes, predictors, and outcomes associated with 30-day and 90-day readmission. Patients and Methods: The Nationwide Readmissions Database was queried (January-September 2013) using ICD-9-CM codes, identifying patients who underwent DBS for movement disorder (Parkinson's disease [PD], essential tremor [ET], or dystonia). Variables included categorical age, gender, insurance, comorbidities, type of movement disorder, length of stay (LOS), total costs, and discharge disposition. Results: A total of 3392 DBS patients were identified [PD (70.7{\%}), ET (25.6{\%}), dystonia (3.7{\%})]. The mean age was 64.8 ± 0.4 years old and 37{\%} were female. The rates of unplanned readmissions was 1.9{\%} at 30-days and 4.3{\%} at 90 days. The overall NRD incidence (all patient populations) of 30-day readmission is 11.6{\%}. Readmissions most frequently resulted from surgical complications including hematoma and attention to surgical wounds. Elderly, obese, and those with comorbidities such as history of stroke or CAD are at highest risk. The average LOS, mean total cost, and rate of adverse discharge were worse for 30-day (9 days, $64,520, 71.7{\%}) compared to 90-day readmission (6 days, $52,183, 56.5{\%}). Conclusion: All-cause, unplanned readmission for DBS was 1.9{\%} within 30-days and 4.3{\%} within 90-days. Risk factors for readmission in our study, such as advanced age and multiple medical comorbidities, are not unique to DBS. Unplanned readmissions are much rarer following DBS compared to most hospital discharges but can occasionally lead to additional costs and rare complications including hematoma, stroke, and wound infection. DBS should continue to be viewed as a safe and effective treatment modality for a wide range of neurological ailments.",
keywords = "Deep brain stimulation, Movement disorders, Readmissions",
author = "Kavelin Rumalla and Smith, {Kyle A.} and Follett, {Kenneth A} and Nazzaro, {Jules M.} and Arnold, {Paul M.}",
year = "2018",
month = "8",
doi = "10.1016/j.clineuro.2018.06.013",
language = "English (US)",
volume = "171",
pages = "129--134",
journal = "Clinical Neurology and Neurosurgery",
issn = "0303-8467",
publisher = "Elsevier",

}

TY - JOUR

T1 - Rates, causes, risk factors, and outcomes of readmission following deep brain stimulation for movement disorders

T2 - Analysis of the U.S. Nationwide Readmissions Database

AU - Rumalla, Kavelin

AU - Smith, Kyle A.

AU - Follett, Kenneth A

AU - Nazzaro, Jules M.

AU - Arnold, Paul M.

PY - 2018/8

Y1 - 2018/8

N2 - Objective: Deep brain stimulation (DBS) surgery has proven benefit for several movement disorders and medically-refractory psychiatric conditions and is considered a fairly safe procedure. We sought to determine the national rates, causes, predictors, and outcomes associated with 30-day and 90-day readmission. Patients and Methods: The Nationwide Readmissions Database was queried (January-September 2013) using ICD-9-CM codes, identifying patients who underwent DBS for movement disorder (Parkinson's disease [PD], essential tremor [ET], or dystonia). Variables included categorical age, gender, insurance, comorbidities, type of movement disorder, length of stay (LOS), total costs, and discharge disposition. Results: A total of 3392 DBS patients were identified [PD (70.7%), ET (25.6%), dystonia (3.7%)]. The mean age was 64.8 ± 0.4 years old and 37% were female. The rates of unplanned readmissions was 1.9% at 30-days and 4.3% at 90 days. The overall NRD incidence (all patient populations) of 30-day readmission is 11.6%. Readmissions most frequently resulted from surgical complications including hematoma and attention to surgical wounds. Elderly, obese, and those with comorbidities such as history of stroke or CAD are at highest risk. The average LOS, mean total cost, and rate of adverse discharge were worse for 30-day (9 days, $64,520, 71.7%) compared to 90-day readmission (6 days, $52,183, 56.5%). Conclusion: All-cause, unplanned readmission for DBS was 1.9% within 30-days and 4.3% within 90-days. Risk factors for readmission in our study, such as advanced age and multiple medical comorbidities, are not unique to DBS. Unplanned readmissions are much rarer following DBS compared to most hospital discharges but can occasionally lead to additional costs and rare complications including hematoma, stroke, and wound infection. DBS should continue to be viewed as a safe and effective treatment modality for a wide range of neurological ailments.

AB - Objective: Deep brain stimulation (DBS) surgery has proven benefit for several movement disorders and medically-refractory psychiatric conditions and is considered a fairly safe procedure. We sought to determine the national rates, causes, predictors, and outcomes associated with 30-day and 90-day readmission. Patients and Methods: The Nationwide Readmissions Database was queried (January-September 2013) using ICD-9-CM codes, identifying patients who underwent DBS for movement disorder (Parkinson's disease [PD], essential tremor [ET], or dystonia). Variables included categorical age, gender, insurance, comorbidities, type of movement disorder, length of stay (LOS), total costs, and discharge disposition. Results: A total of 3392 DBS patients were identified [PD (70.7%), ET (25.6%), dystonia (3.7%)]. The mean age was 64.8 ± 0.4 years old and 37% were female. The rates of unplanned readmissions was 1.9% at 30-days and 4.3% at 90 days. The overall NRD incidence (all patient populations) of 30-day readmission is 11.6%. Readmissions most frequently resulted from surgical complications including hematoma and attention to surgical wounds. Elderly, obese, and those with comorbidities such as history of stroke or CAD are at highest risk. The average LOS, mean total cost, and rate of adverse discharge were worse for 30-day (9 days, $64,520, 71.7%) compared to 90-day readmission (6 days, $52,183, 56.5%). Conclusion: All-cause, unplanned readmission for DBS was 1.9% within 30-days and 4.3% within 90-days. Risk factors for readmission in our study, such as advanced age and multiple medical comorbidities, are not unique to DBS. Unplanned readmissions are much rarer following DBS compared to most hospital discharges but can occasionally lead to additional costs and rare complications including hematoma, stroke, and wound infection. DBS should continue to be viewed as a safe and effective treatment modality for a wide range of neurological ailments.

KW - Deep brain stimulation

KW - Movement disorders

KW - Readmissions

UR - http://www.scopus.com/inward/record.url?scp=85048414757&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85048414757&partnerID=8YFLogxK

U2 - 10.1016/j.clineuro.2018.06.013

DO - 10.1016/j.clineuro.2018.06.013

M3 - Article

C2 - 29909184

AN - SCOPUS:85048414757

VL - 171

SP - 129

EP - 134

JO - Clinical Neurology and Neurosurgery

JF - Clinical Neurology and Neurosurgery

SN - 0303-8467

ER -