Factors related to extended hospital stays following deep brain stimulation for Parkinson's disease
Factors related to extended hospital stays following deep brain stimulation for Parkinson's disease
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DOI：
10.1016/j.parkreldis.2010.02.002
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发表时间：
2010-06-01
影响因子：
4.1
通讯作者：
Okun, Michael S.
中科院分区：
文献类型：
--
作者：
Mikos, Ania;Pavon, Juliessa;Okun, Michael S.
目的：帕金森病（PD）患者通常在深部脑刺激（DBS）手术后第二天出院，然而，延长住院时间的因素在很大程度上是未知的。本研究探讨了单侧DBS手术后可能增加术后住院时间的潜在因素。方法：对115例单侧PD - DBS患者进行回顾性分析。年龄、性别、微电极次数、病程和病情严重程度以及术前神经心理学评分被认为是影响住院时间的可能因素。结果：大多数患者（79%）术后住院1天。延迟出院最常见的原因包括精神状态改变（N = 6）和出血（N = 5）。延迟出院的患者术前认知筛查得分（Mini-Mental State Evaluation， MMSE）显著低于立即出院的患者，术前“开”药物运动得分较高，微电极通过率也高于立即出院的患者。在相关分析中，住院时间的增加与更多的微电极通过、更高的术前“开”药物运动评分和降低的MMSE评分显著相关。当初步分析中的重要变量被输入泊松回归模型时，更多的微电极通过次数和较低的MMSE分数仍然是延长住院时间的重要预测因素。结论：DBS手术中使用的微电极次数以及患者的一般认知状态可能是延长住院时间的重要因素。UPDRS“on”用药运动评分也可能对单侧DBS患者术后立即发病提供一定的预测能力。(C) 2010 Elsevier Ltd.版权所有。
Objective: Patients with Parkinson's disease (PD) are typically discharged from the hospital the day following deep brain stimulation (DBS) surgery: however, factors extending hospital stay are largely unknown. This study examined potential factors that might have corresponded to increased postoperative stays following unilateral DBS surgery.Methods: A retrospective review was performed on 115 unilateral PD DBS patients. Age, gender, number of microelectrode passes, duration and severity of illness, and pre-operative neuropsychological scores were considered as possible contributors to length of stay.Results: Most patients (79%) had a hospital stay of one day following surgery. The most frequent reasons for delayed discharge (>1 day) included mental status change (N = 6) and hemorrhage (N = 5). Those with delayed discharge had significantly lower pre-surgical cognitive screening scores (Mini-Mental State Evaluation; MMSE), higher pre-surgical "on" medication motor score, and more microelectrode passes than those with immediate discharge. In correlation analyses, increasing length of hospital stay was significantly associated with more microelectrode passes, higher pre-surgical "on" medication motor scores, and decreasing MMSE scores. When the significant variables from the preliminary analyses were entered into a Poisson regression model, a greater number of microelectrode passes as well as lower MMSE scores remained significant predictors of increased length of stay.Conclusions: The number of microelectrode passes utilized for DBS surgery as well as a patient's general cognitive status may be important factors related to extended hospital stay. UPDRS "on" medication motor score may also provide some predictive power for immediate post-operative morbidity in unilateral DBS patients. (C) 2010 Elsevier Ltd. All rights reserved.