Comparison of Bilateral vs. Staged Unilateral Deep Brain Stimulation (DBS) in Parkinson's Disease in Patients Under 70 Years of Age.
Comparison of Bilateral vs. Staged Unilateral Deep Brain Stimulation (DBS) in Parkinson's Disease in Patients Under 70 Years of Age.
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DOI：
10.1111/ner.12351
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发表时间：
2016-01
期刊：
影响因子：
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通讯作者：
Lad SP
中科院分区：
文献类型：
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作者：
Petraglia FW 3rd;Farber SH;Han JL;Verla T;Gallis J;Lokhnygina Y;Parente B;Hickey P;Turner DA;Lad SP
在帕金森病（PD）患者中，最常用的脑深部电刺激（DBS）手术方法是同时双侧DBS。然而，一些临床试验机构采用分期单侧入路，主张减少连续术中时间可减少术后并发症，从而证明第二次手术的成本合理。为了验证这些假设，我们对Truven Health MarketScan®数据库进行了回顾性分析。使用MarketScan®数据库，我们回顾性分析了2000年至2009年间同时接受双侧或分期单侧DBS的患者。主要结局指标为术后90天并发症发生率、术后一年的再编程小时数和年度医疗费用。使用多变量回归控制适当的协变量，比较队列之间的结局指标。在2000年至2009年期间接受DBS治疗的713名患者符合本研究的入选标准。在这些患者中，556例同时接受双侧DBS，157例接受分期单侧DBS。在感染率方面，两组之间没有统计学显著差异（同期：4.3% vs.分期：7.0%; p=0.178），肺炎（3.1% vs. 5.7%; p=0.283）、出血（2.9% vs. 2.5%; p=0.844）、肺栓塞（0.5% vs. 1.3%）和器械相关并发症（0.5% vs. 0.0%）。分期队列中的患者在90天内的电极导线翻修率较高（3.2% vs. 12.7%; RR=3.07; p<0.001）。分期队列在手术后1年内的平均（SD）重编程小时数较高（6.0±5.7 vs. 7.8±8.1; RR=1.17; p<0.001）。队列之间的平均（SD）年化付款无显著差异（86，100 ± 94，700美元vs. 102，100 ± 121，500美元; p=0.148）。我们的研究没有发现分期组和同期组之间的90天术后并发症发生率或年化成本有显著差异。因此，我们认为，在决定分期DBS和同步DBS时，考虑其他因素是很重要的。这些因素包括患者的便利性和症状的偏侧性。
The most popular surgical method for deep brain stimulation (DBS) in Parkinson's Disease (PD) is simultaneous bilateral DBS. However, some centers conduct a staged unilateral approach advocating that reduced continuous intraoperative time reduces post-operative complications, thus justifying the cost of a second operative session. To test these assumptions, we performed a retrospective analysis of the Truven Health MarketScan® Database. Using the MarketScan® Database, we retrospectively analyzed patients that underwent simultaneous bilateral or staged unilateral DBS between 2000 and 2009. The main outcome measures were 90-day post-operative complication rates, number of reprogramming hours one year following procedure, and annualized healthcare cost. The outcome measures were compared between cohorts using multivariate regressions controlling for appropriate covariates. A total of 713 patients that underwent DBS between 2000 and 2009 met inclusion criteria for the study. Of these patients, 556 underwent simultaneous bilateral DBS and 157 received staged unilateral DBS. No statistically significant differences were found between groups in the rate of infection (simultaneous: 4.3% vs. staged: 7.0%; p=0.178), pneumonia (3.1% vs. 5.7%; p=0.283), hemorrhage (2.9% vs. 2.5%; p=0.844), pulmonary embolism (0.5% vs. 1.3%), and device-related complications (0.5% vs. 0.0%). Patients in the staged cohort had a higher rate of lead revision in 90 days (3.2% vs. 12.7%; RR=3.07; p<.001). The staged cohort had a higher mean (SD) number of reprogramming hours within 1 year of procedure (6.0±5.7 vs. 7.8±8.1; RR=1.17; p<0.001). No significant difference was found between the mean (SD) annualized payments between the cohorts ($86,100±$94,700 vs. $102,100±$121,500; p=0.148). Our study did not find a significant difference between 90-day post-operative complication rates or annualized cost between the staged and simultaneous cohorts. Thus, we believe that it is important to consider other factors when deciding between the staged and simultaneous DBS. Such factors include patient convenience and the laterality of symptoms.