Effect of Advancing Age on Outcomes of Deep Brain Stimulation for Parkinson Disease
Effect of Advancing Age on Outcomes of Deep Brain Stimulation for Parkinson Disease
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DOI：
10.1001/jamaneurol.2014.1272
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发表时间：
2014-10-01
期刊：
影响因子：
29
通讯作者：
Lad, Shivanand P.
中科院分区：
文献类型：
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作者：
DeLong, Michael R.;Huang, Kevin T.;Lad, Shivanand P.
脑深部电刺激（DBS）是治疗晚期帕金森病（PD）的一种成熟模式。最近的研究发现，对于患有PD和早期运动并发症的患者，DBS加最佳药物治疗上级优于单独的最佳药物治疗。虽然没有定义具体的年龄截止值，但大多数临床研究排除了75岁以上的患者。我们假设年龄的增加与术后并发症的增加有关。目的评估年龄增加的逐步影响（5年）DBS手术后短期并发症的研究。设计，设置和参与者一个大型，使用Thomson路透社MarketScan国家数据库进行了回顾性队列研究，该数据库检查了1757例在此期间接受DBS治疗PD的患者主要观察指标包括住院时间、术后90天内的合并症和个别并发症。在控制协变量后，采用多变量logistic回归分析计算每个5岁年龄段的并发症相关优势比（OR）。（7.5%）在90天内至少发生1起并发症，包括伤口感染肺炎（2.3%）、出血或血肿（1.4%）或肺栓塞（0.6%）。在调整协变量后，我们发现，与年轻同行相比，年龄增加（75岁以上）的DBS手术患者显示出相似的90天并发症风险（包括术后出血或感染）。我们的研究结果表明，年龄本身不应该是决定DBS候选人资格的主要排除因素。相反，明确关注药物难治性和难以控制开关波动的患者，无论年龄大小，都可以扩大传统的治疗窗口。
IMPORTANCE Deep brain stimulation (DBS) is a well-established modality for the treatment of advanced Parkinson disease (PD). Recent studies have found DBS plus best medical therapy to be superior to best medical therapy alone for patients with PD and early motor complications. Although no specific age cutoff has been defined, most clinical studies have excluded patients older than 75 years of age. We hypothesize that increasing age would be associated with an increased number of postoperative complications.OBJECTIVE To evaluate the stepwise effect of increasing age (in 5-year epochs) on short-term complications following DBS surgery.DESIGN, SETTING, AND PARTICIPANTS A large, retrospective cohort study was performed using the Thomson Reuters MarketScan national database that examined 1757 patients who underwent DBS for PD during the period from 2000 to 2009.MAIN OUTCOMES AND MEASURES Primary measures examined included hospital length of stay and aggregate and individual complications within 90 days following surgery. Multivariate logistic regression analysis was used to calculate complication-related odds ratios (ORs) for each 5-year age epoch after controlling for covariates.RESULTS Overall, 132 of 1757 patients (7.5%) experienced at least 1 complication within 90 days, including wound infections (3.6%), pneumonia (2.3%), hemorrhage or hematoma (1.4%), or pulmonary embolism (0.6%). After adjusting for covariates, we found that increasing age (ranging from 75 years) who were selected to undergo DBS surgery showed a similar 90-day complication risk (including postoperative hemorrhage or infection) compared with younger counterparts. Our findings suggest that age alone should not be a primary exclusion factor for determining candidacy for DBS. Instead, a clear focus on patients with medication-refractory and difficult to control on-off fluctuations with preserved cognition, regardless of age, may allow for an expansion of the traditional therapeutic window.