In-hospital Complications of Movement Disorder Surgery in the United StatesAnand Indulal Rughani, MD1, Bruce Tranmer, MD1, Michael Horgan, MD1, Paul Penar, MD1, Travis Dumont, MD11Burlington, VT United States Keywords: movement disorder, deep brain stimulation, complications, radiosurgery, thalamotomy
Surgical complication rates are important to study.
We hypothesized that age is associated with increased complication rates in movement disorder surgery.
We queried the Nationwide Inpatient Sample (NIS) for years 1999 to 2008. We included all patients with principal diagnosis of primary Parkinson’s Disease (ICD9 = 332.0), essential tremor (333.1), or dystonia (333.6, 333.7) who underwent a principal procedure including thalamotomy (01.41), pallidotomy (01.42), deep brain stimulator placement (02.93), or stereotactic radiosurgery (92.3). We excluded all patients under age 18, and all patients who underwent primary procedure more than three days after admission.
Groups were compared with t-test, Kruskal-Wallis test and Dunn''''s test.
We identified 5,585 patients who met selection criteria. Patients with Parkinson’s disease comprised 74.2% (n=4159) of the sample, followed by essential tremor (22.9%), and dystonia (2.4%). Most patients underwent DBS (n=4,961), followed by ablative procedures (n=564) and radiosurgery (n=118). There were no differences in in-hospital mortality rates between treatment modes (0.3% in DBS, 0.2% in ablative procedures, and 0% in radiosurgery). There were no differences in rates of peri-operative in-hospital complications (2.8% in DBS, 2.6% in ablative procedures, and 0.8% in radiosurgery). Age over 65 increased the mortality from 0.1% to 0.4% (p<0.05) and complication rate from 2.2% to 3.3% (p<0.05). Patients with Parkinson’s Disease had higher in-hospital mortality (0.7%) compared to those with essential tremor (0.2%; p<0.05), as well as higher complication rates (3.1% vs. 1.4%; p<0.01).
This is a retrospective study.
Within a 10-year sample of the NIS, age and primary diagnosis were associated with increased peri-operative complications and mortality.
Type of treatment modality did not correlate with risk. Project Roles:
A. Rughani (), B. Tranmer (), M. Horgan (), P. Penar (), T. Dumont ()