1
|
Bishay AE, Lyons AT, Koester SW, Paulo DL, Liles C, Dambrino RJ, Feldman MJ, Ball TJ, Bick SK, Englot DJ, Chambless LB. Global Economic Evaluation of the Reported Costs of Deep Brain Stimulation. Stereotact Funct Neurosurg 2024:1-17. [PMID: 38513625 DOI: 10.1159/000537865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 02/13/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION Despite the known benefits of deep brain stimulation (DBS), the cost of the procedure can limit access and can vary widely. Our aim was to conduct a systematic review of the reported costs associated with DBS, as well as the variability in reporting cost-associated factors to ultimately increase patient access to this therapy. METHODS A systematic review of the literature for cost of DBS treatment was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed and Embase databases were queried. Olsen & Associates (OANDA) was used to convert all reported rates to USD. Cost was corrected for inflation using the US Bureau of Labor Statistics Inflation Calculator, correcting to April 2022. RESULTS Twenty-six articles on the cost of DBS surgery from 2001 to 2021 were included. The median number of patients across studies was 193, the mean reported age was 60.5 ± 5.6 years, and median female prevalence was 38.9%. The inflation- and currency-adjusted mean cost of the DBS device was USD 21,496.07 ± USD 8,944.16, the cost of surgery alone was USD 14,685.22 ± USD 8,479.66, the total cost of surgery was USD 40,942.85 ± USD 17,987.43, and the total cost of treatment until 1 year of follow-up was USD 47,632.27 ± USD 23,067.08. There were no differences in costs observed across surgical indication or country. CONCLUSION Our report describes the large variation in DBS costs and the manner of reporting costs. The current lack of standardization impedes productive discourse as comparisons are hindered by both geographic and chronological variations. Emphasis should be put on standardized reporting and analysis of reimbursement costs to better assess the variability of DBS-associated costs in order to make this procedure more cost-effective and address areas for improvement to increase patient access to DBS.
Collapse
Affiliation(s)
- Anthony E Bishay
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - Stefan W Koester
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Danika L Paulo
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Campbell Liles
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert J Dambrino
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael J Feldman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Tyler J Ball
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sarah K Bick
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Dario J Englot
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lola B Chambless
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
2
|
Olson MC, Shill H, Ponce F, Aslam S. Deep brain stimulation in PD: risk of complications, morbidity, and hospitalizations: a systematic review. Front Aging Neurosci 2023; 15:1258190. [PMID: 38046469 PMCID: PMC10690827 DOI: 10.3389/fnagi.2023.1258190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/30/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction Parkinson's disease (PD) is a progressive and debilitating neurological disorder. While dopaminergic medication improves PD symptoms, continued management is complicated by continued symptom progression, increasing medication fluctuations, and medication-related dyskinesia. Deep brain stimulation (DBS) surgery is a well-accepted and widespread treatment often utilized to address these symptoms in advanced PD. However, DBS may also lead to complications requiring hospitalization. In addition, patients with PD and DBS may have specialized care needs during hospitalization. Methods This systematic review seeks to characterize the complications and risk of hospitalization following DBS surgery. Patient risk factors and modifications to DBS surgical techniques that may affect surgical risk are also discussed. Results It is found that, when candidates are carefully screened, DBS is a relatively low-risk procedure, but rate of hospitalization is somewhat increased for DBS patients. Discussion More research is needed to determine the relative influence of more advanced disease vs. DBS itself in increased rate of hospitalization, but education about DBS and PD is important to insure effective patient care within the hospital.
Collapse
Affiliation(s)
- Markey C. Olson
- Department of Neurology, Muhammad Ali Movement Disorders Clinic, Barrow Neurological Institute, St Joseph’s Hospital and Medical Center, Phoenix, AZ, United States
- Department of Neurosurgery, Barrow Brain and Spine, Barrow Neurological Institute, St Joseph’s Hospital and Medical Center, Phoenix, AZ, United States
| | - Holly Shill
- Department of Neurology, Muhammad Ali Movement Disorders Clinic, Barrow Neurological Institute, St Joseph’s Hospital and Medical Center, Phoenix, AZ, United States
| | - Francisco Ponce
- Department of Neurosurgery, Barrow Brain and Spine, Barrow Neurological Institute, St Joseph’s Hospital and Medical Center, Phoenix, AZ, United States
| | - Sana Aslam
- Department of Neurology, Muhammad Ali Movement Disorders Clinic, Barrow Neurological Institute, St Joseph’s Hospital and Medical Center, Phoenix, AZ, United States
| |
Collapse
|
3
|
Cui Z, Chen T, Wang J, Jiang C, Gao Q, Mao Z, Pan L, Ling Z, Zhang J, Li X. The Long-Term Efficacy, Prognostic Factors, Safety, and Hospitalization Costs Following Denervation and Myotomy of the Affected Muscles and Deep Brain Stimulation in 94 Patients with Spasmodic Torticollis. Brain Sci 2022; 12:brainsci12070881. [PMID: 35884688 PMCID: PMC9313216 DOI: 10.3390/brainsci12070881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/26/2022] [Accepted: 06/27/2022] [Indexed: 02/01/2023] Open
Abstract
The surgical methods for treating spasmodic torticollis include the denervation and myotomy (DAM) of the affected muscles and deep brain stimulation (DBS). This study reports on the long-term efficacy, prognostic factors, safety, and hospitalization costs following these two procedures. We collected data from 94 patients with spasmodic torticollis, of whom 41 and 53 were treated with DAM and DBS, respectively, from June 2008 to December 2020 at the Chinese People’s Liberation Army General Hospital. We used the Tsui scale and the global outcome score of the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) to evaluate the preoperative and postoperative clinical conditions in all patients. We also determined the costs of hospitalization, prognostic factors, and serious adverse events following the two surgical procedures. The mean follow-up time was 68.83 months (range = 13–116). Both resection surgery and DBS showed good results in terms of Tsui (Z = −5.103, p = 0.000; Z = −6.210, p = 0.000) and TWSTRS scores (t = 8.762, p = 0.000; Z = −6.308, p = 0.000). Compared with the DAM group, the preoperative (47.71, range 24–67.25) and postoperative (18.57, range 0–53) TWSTRS scores in the DBS group were significantly higher (Z = −3.161, p = 0.002). We found no correlation between prognostic factors and patient age, gender, or disease duration for either surgical procedure. However, prognostic factors were related to the length of the postoperative follow-up period in the DBS surgery group (Z = −2.068, p = 0.039; Z = −3.287, p = 0.001). The mean hospitalization cost in the DBS group was 6.85 times that found in the resection group (Z = −8.284, p = 0.000). The total complication rate was 4.26%. We found both resection surgery and DBS showed good results in the patients with spasmodic torticollis. Compared with DAM, DBS had a greater improvement in TWSTRS score; however, it was more expensive. Prognostic factors were related to the length of the postoperative follow-up period in patients who underwent DBS surgery.
Collapse
Affiliation(s)
- Zhiqiang Cui
- Department of Neurosurgery, The First Medical Clinical Center, PLA General Hospital, Beijing 100853, China; (Z.C.); (J.W.); (Z.M.); (L.P.); (Z.L.); (J.Z.)
| | - Tong Chen
- Department of Neurology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China;
| | - Jian Wang
- Department of Neurosurgery, The First Medical Clinical Center, PLA General Hospital, Beijing 100853, China; (Z.C.); (J.W.); (Z.M.); (L.P.); (Z.L.); (J.Z.)
| | - Chao Jiang
- School of Basic Medical Sciences, North China University of Science and Technology, No. 21 Bohai Road, Caofeidian Eco-City, Tangshan 063210, China; (C.J.); (Q.G.)
| | - Qingyao Gao
- School of Basic Medical Sciences, North China University of Science and Technology, No. 21 Bohai Road, Caofeidian Eco-City, Tangshan 063210, China; (C.J.); (Q.G.)
| | - Zhiqi Mao
- Department of Neurosurgery, The First Medical Clinical Center, PLA General Hospital, Beijing 100853, China; (Z.C.); (J.W.); (Z.M.); (L.P.); (Z.L.); (J.Z.)
| | - Longsheng Pan
- Department of Neurosurgery, The First Medical Clinical Center, PLA General Hospital, Beijing 100853, China; (Z.C.); (J.W.); (Z.M.); (L.P.); (Z.L.); (J.Z.)
| | - Zhipei Ling
- Department of Neurosurgery, The First Medical Clinical Center, PLA General Hospital, Beijing 100853, China; (Z.C.); (J.W.); (Z.M.); (L.P.); (Z.L.); (J.Z.)
| | - Jianning Zhang
- Department of Neurosurgery, The First Medical Clinical Center, PLA General Hospital, Beijing 100853, China; (Z.C.); (J.W.); (Z.M.); (L.P.); (Z.L.); (J.Z.)
| | - Xuemei Li
- Cadre Medical Department, The First Medical Clinical Center, PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing 100853, China
- Correspondence: ; Fax: +10-66938442
| |
Collapse
|
4
|
Kortz MW, Kongs BM, McCray E, Grassia F, Hosokawa P, Bernstein JE, Moore SP, Yanovskaya M, Ojemann SG. How neuropsychiatric comorbidity, modulatory indication, demographics, and other factors impact deep brain stimulation inpatient outcomes in the United States: A population-based study of 27,956 patients. Clin Neurol Neurosurg 2021; 208:106842. [PMID: 34339900 DOI: 10.1016/j.clineuro.2021.106842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine how neuropsychiatric comorbidity, modulatory indication, demographics, and other characteristics affect inpatient deep brain stimulation (DBS) outcomes. METHODS This is a retrospective study of 45 months' worth of data from the National Inpatient Sample. Patients were aged ≥ 18 years old and underwent DBS for Parkinson Disease (PD), essential tremor (ET), general dystonia and related disorders, other movement disorder (non-PD/ET), or obsessive-compulsive disorder (OCD) at a US hospital. Primary endpoints were prolonged length of stay (PLOS), high-end hospital charges (HEHCs), unfavorable disposition, and inpatient complications. Logistic models were constructed with odds ratios under 95% confidence intervals. A p-value of 0.05 determined significance. RESULTS Of 214,098 records, there were 27,956 eligible patients. Average age was 63.9 ± 11.2 years, 17,769 (63.6%) were male, and 10,182 (36.4%) patients were female. Most of the cohort was White (51.1%), Medicare payer (64.3%), and treated at a large-bed size (80.7%), private non-profit (76.9%), and metro-teaching (94.0%) hospital. Neuropsychiatric comorbidity prevalence ranged from 29.9% to 47.7% depending on indication. Compared with PD, odds of complications and unfavorable disposition were significantly higher with other movement disorders and dystonia, whereas OCD conferred greater risk for HEHCs (p < 0.05). Patients with ET had favorable outcomes. Neuropsychiatric comorbidity, Black race, and Charlson Comorbidity Index > 0 were significantly associated with unfavorable outcomes (p < 0.05). CONCLUSION The risk of adverse inpatient outcomes for DBS in the United States is independently correlated with non-PD/ET disorders, neuropsychiatric comorbidity, and non-White race, reflecting the heterogeneity and infancy of widespread DBS for these patients.
Collapse
Affiliation(s)
- Michael W Kortz
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Brian M Kongs
- College of Osteopathic Medicine, Kansas City University, Kansas City, MO, USA
| | - Edwin McCray
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Fabio Grassia
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Patrick Hosokawa
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jacob E Bernstein
- Department of Neurosurgery, Riverside University Health System, Riverside, CA, USA
| | - Sean P Moore
- College of Osteopathic Medicine, Kansas City University, Kansas City, MO, USA
| | - Mariya Yanovskaya
- College of Osteopathic Medicine, Kansas City University, Kansas City, MO, USA
| | - Steven G Ojemann
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA
| |
Collapse
|
5
|
Kaur J, Sandhu RK, Kubra KT, Canenguez Benitez JS, Onyeaka HK, Akter S, Amuk Williams OC. Substance Use Disorders in Patients With Parkinson's Disease and Adverse Hospitalization Outcomes: A National Inpatient Study. Cureus 2021; 13:e16033. [PMID: 34336520 PMCID: PMC8321420 DOI: 10.7759/cureus.16033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives To understand the demographic pattern of substance use disorders (SUD) in Parkinson’s disease (PD) inpatients and to evaluate the impact of SUD on hospitalization outcomes including the severity of illness, length of stay (LOS), total charges, and disposition to nursing facilities. Methods We used the nationwide inpatient sample and identified adult patients (age, ≥40 years) with PD as a primary diagnosis and comorbid SUD (N = 959) and grouped by co-diagnosis of alcohol (N = 789), cannabis (N = 46), opioid (N = 30), stimulants (N = 54) and barbiturate (N = 40) use disorders. We used a binomial logistic regression model to evaluate the odds ratio (OR) for major loss of functioning and disposition to nursing facilities in PD inpatients. All regression models were adjusted for demographics, including age, sex, race, and median household income. Results Alcohol, opioid, and stimulant use disorders were prevalent in old-age adults (60-79 years), males, and whites, but cannabis use was prevalent in middle-aged adults (40-59 years), and barbiturate use among older-age (>80 years). The severity of illness is statistically higher in PD inpatients with comorbid opioid and barbiturate use disorders with major loss of body functioning, closely seconded by alcohol and stimulant use disorder cohorts (27.6% and 25.9%, respectively). Disease severity and loss of body functioning increase with advancing age (>80 years adults, OR 5.8, 95%CI 5.32-6.37), and in blacks (OR 1.7, 95%CI 1.56-1.81), and those with opioid use disorder (OR 3.8, 95%CI 1.96-7.35). PD inpatients with barbiturate use disorder had a higher LOS and charges by 17.4 days and $68,922, and six-fold increased likelihood (95%CI 2.33-15.67) for disposition to nursing facilities. Conclusions SUD is prevalent among PD patients and is associated with more severe illnesses with body loss functioning and prolonged care. A multidisciplinary care model including collaborative neuropsychiatric and addiction management is required to manage SUD among PD patients to lessen disease severity, slow down the disease progression and potentially save medical costs.
Collapse
Affiliation(s)
| | - Ramneek K Sandhu
- Internal Medicine, Shri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, IND
| | - Khadija T Kubra
- Internal Medicine, Bangladesh Medical College and Hospital, Dhaka, BGD
| | | | | | - Sabiha Akter
- Psychiatry, Bergen New Bridge Medical Center, Paramus, USA
| | | |
Collapse
|
6
|
Deng H, Yue JK, Wang DD. Trends in safety and cost of deep brain stimulation for treatment of movement disorders in the United States: 2002-2014. Br J Neurosurg 2020; 35:57-64. [PMID: 32476485 DOI: 10.1080/02688697.2020.1759776] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Deep brain stimulation (DBS) is being increasingly utilized to treat movement disorders including Parkinson's disease (PD), essential tremor (ET), and dystonia. An improved understanding of national trends in safety and cost is necessary. Herein, our objectives are to (1) characterize complication, mortality, and cost profiles of patients undergoing DBS for movement disorders in the United States, (2) identify predictors of morbidity and mortality, and (3) evaluate impact of complications on cost. METHODS DBS surgeries were extracted from the National Inpatient Sample (NIS) 2002-2014 for the clinical indications of PD, ET, and dystonia. Patient characteristics and eight complication categories (hardware malfunction, infection, neurological, other haemorrhagic, thromboembolic, cardiac, pulmonary, and renal/urinary) were reviewed. Outcomes included complications, mortality, hospitalization length, and inflation-adjusted cost. RESULTS There were 44,866 weighted admissions (PD-73.5%, ET-22.7%, dystonia-3.8%). The number of procedures increased 2.22-fold from 2002 to 2014 (N = 2372 in 2002; N = 5260 in 2014). Inpatient cost was $22,802 ± 13,164, remaining stable from 2002 to 2014 ($24,188 ± 15,910, $20,630 ± 11,031, respectively). Four percent experienced complications (dystonia-6.0%, PD-4.4%, ET-3.1%, p < .001). In-hospital mortality was 0.2%. Cost was greater in patients with complications ($36,306 ± 29,263 vs. $22,196 ± 11,560, p < .001). Most common complications were renal/urinary (1.5%), neurological (1.1%), and pulmonary (0.7%). Thromboembolic, pulmonary, and haemorrhagic complications were associated with greatest cost. CONCLUSION Increased DBS utilization for adult movement disorders in the United States from 2002 to 2014 was attributed to rapid adoption by teaching hospitals for PD. DBS remains a safe procedure with low overall complications and stable inpatient costs from 2002 to 2014. Complication risks vary by type of movement disorder, and although rare, multiple complications increase morbidity and cost of care.
Collapse
Affiliation(s)
- Hansen Deng
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - John K Yue
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Doris D Wang
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| |
Collapse
|
7
|
Sharma M, Ugiliweneza B, Wang D, Boakye M, Andaluz N, Neimat J, Mohammadi A, Barnett GH, Williams BJ. National Trends and Factors Predicting Outcomes Following Laser Interstitial Thermal Therapy for Brain Lesions: Nationwide Inpatient Sample Analysis. World Neurosurg 2020; 139:e88-e97. [PMID: 32251808 DOI: 10.1016/j.wneu.2020.03.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Laser interstitial thermal therapy (LITT) is a stereotactic-guided technique, which is increasingly being performed for brain lesions. The aim of our study was to report the national trends and factors predicting the clinical outcomes following LITT using the Nationwide Inpatient Sample. METHODS We extracted data from 2011-2016 using ICD-9/10 codes. Patients with a primary procedure of LITT were included. Patient demographics, complications, length of hospital stay, discharge disposition, and index-hospitalization charges were analyzed. RESULTS A cohort of 1768 patients was identified from the database. Mean length of hospital stay was 3.2 days, 82% of patients were discharged to home, and in-hospitalization cost was $124,225. Complications and mortality were noted in 12.9% and 2.5% of patients following LITT, respectively. Non-Caucasian patients (estimate ratio [ER] 4.26), those with other insurance (compared with commercial, ER: 5.35), 3 and 4+ comorbidity indexes, patients with higher quartile median household income (second, third, and fourth quartile compared with first quartile), and those who underwent nonelective procedures were likely to have higher complications and less likely to be discharged home. Patients with 4+ comorbidity indexes were likely to have longer length of hospital stay (ER 1.39) and higher complications (ER: 7.95) and were less likely to be discharged home (ER: 0.17) and have higher in-hospitalization cost (ER: 1.21). CONCLUSIONS LITT is increasingly being performed with low complication rates. Non-Caucasian race, higher comorbidity index, noncommercial insurance, and nonelective procedures were predictors of higher complications and being less likely to be discharged home. In-hospitalization charges were higher in patients with higher comorbidity index and those with noncommercial insurance.
Collapse
Affiliation(s)
- Mayur Sharma
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | | | - Dengzhi Wang
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Maxwell Boakye
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Norberto Andaluz
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Joseph Neimat
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Alireza Mohammadi
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Gene H Barnett
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Brian J Williams
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA.
| |
Collapse
|
8
|
Katati MJ, Jover VA, Iañez VB, Navarro PMJ, de la Cruz SJ, García OG, Escamilla SF, Mínguez CA. An initial experience with intraoperative O-Arm for deep brain stimulation surgery: can it replace post-operative MRI? Acta Neurol Belg 2020; 120:295-301. [PMID: 30406497 DOI: 10.1007/s13760-018-1037-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/30/2018] [Indexed: 10/27/2022]
Abstract
Deep brain stimulation (DBS) is used to treat movement disorders, severe psychiatric disorders, and neuropathic pain, among other diseases. Advanced neuroimaging techniques allow direct or indirect localization of the target site, which is verified in many centers by the intraoperative recording of unitary neuronal activity. Intraoperative image acquisition technology (e.g., O-Arm) is increasingly used for accurate electrode positioning throughout the surgery. The aim of our study is to analyze the initial experience of our team in the utilization of O-Arm for planning DBS and monitoring its precision and accuracy throughout the procedure. The study included 13 patients with movement disorders. All underwent DBS with the intraoperative O-arm image acquisition system (iCT) and Medtronic StealthStation S7 cranial planning system, placing a total of 25 electrodes. For each patient, we calculated the difference between real and theoretic x, y, z coordinates, using the paired Student's t test to evaluate absolute and directional differences and the one-sample Student's t test to analyze differences in Euclidean distances. No statistically significant differences were found in absolute, directional, or Euclidean distances between intended and actual x, y, and z coordinates, based on iCT scan. Our experience confirms that utilization of the O-Arm system in DBS provides accurate and precise verification of electrode placements throughout the procedure. Recent studies found no significant differences between iCT and postoperative MRI, the current gold standard. Further prospective studies are warranted to test the elimination of postoperative MRI when this system is used.
Collapse
|
9
|
Acute readmission following deep brain stimulation surgery for Parkinson's disease: A nationwide analysis. Parkinsonism Relat Disord 2020; 70:96-102. [DOI: 10.1016/j.parkreldis.2019.11.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 08/23/2019] [Accepted: 11/25/2019] [Indexed: 01/28/2023]
|
10
|
Pei KY, Richmond R, Dissanaike S. Surgical instrument standardization - A pilot cost consciousness curriculum for surgery residents. Am J Surg 2019; 219:295-298. [PMID: 31629464 DOI: 10.1016/j.amjsurg.2019.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 09/07/2019] [Accepted: 10/07/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Surgical cost is astronomical in the US and instrument standardization is one potential mechanism for cost savings. This study describes a core competency based, multidisciplinary curriculum and evaluates resident attitudes towards operating room equipment standardization. MATERIALS AND METHODS As part of a quality improvement initiative, surgery residents participated in an hour-long mixed curriculum consisting of brief didactics and small group exercises. Participants developed an equipment standardization plan for laparoscopic appendectomy and cholecystectomy. Participants also completed surveys to assess their attitudes towards 11 potential barriers to implementation as "improves, no change, or worsens". RESULTS Fifteen general surgery residents participated. In general, participants felt that standardization improves or does not change metrics including surgeon autonomy, resident training experience, and patient safety. CONCLUSION Our pilot curriculum addresses a gap in resident education about surgical cost. Residents generally regard equipment standardization as either improving or not changing hospital metrics.
Collapse
Affiliation(s)
- Kevin Y Pei
- Houston Methodist Hospital, Houston, TX, USA.
| | - Robyn Richmond
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Sharmila Dissanaike
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| |
Collapse
|
11
|
Consumer Prices for Surgical Management of Ankle Arthritis: Limited Availability and Wide Variability. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2019; 3:e011. [PMID: 31579879 PMCID: PMC6743984 DOI: 10.5435/jaaosglobal-d-19-00011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Healthcare costs for the surgical management of ankle arthritis continue to rise. Patients are generally unaware of the prices of the services they use. Understanding the costs associated with surgical management of ankle arthritis is an important facet of patient care. The purposes of this study were to (1) determine the access to the surgical cost of total ankle arthroplasty (TAAs) and ankle arthrodesis and (2) the variability of the price between the two procedures. Methods: Fifty foot and ankle centers (25 academic, 25 private) that perform TAAs and ankle arthrodeses were contacted using a standardized patient script. The described patient was a 63-year-old man who had failed conservative treatment of ankle arthritis. Each institution was contacted up to three times in an attempt to obtain a full-bundled surgical quote for a TAA and an ankle arthrodesis. Results: Twenty-one centers (42%, 14 academic, 7 private) were able to provide a quote for a TAA and an ankle arthrodesis. The mean bundled price for a TAA was $50,332 (SD ± $25,744), with the mean academic and private center quote being $56,529 and $37,937, respectively. The mean bundled price for an ankle arthrodesis was $41,756 (SD ± $26,033), with the mean academic and private center quote being $48,116 and $29,037, respectively. No statistically significant difference was found between the bundled prices for TAA and ankle arthrodesis. Discussion: This study demonstrated limited availability of consumer prices for TAA and ankle arthrodesis. When comparing different institutions for surgical management of ankle arthritis, there was a wide range of quotes for both TAA and ankle arthrodesis. When comparing the choice of surgical management for ankle arthritis, no statistically significant difference was observed in price between TAA and ankle arthrodesis.
Collapse
|
12
|
Fana M, Everett G, Fagan T, Mazzella M, Zahedi S, Clements JM. Procedural outcomes of deep brain stimulation (DBS) surgery in rural and urban patient population settings. J Clin Neurosci 2019; 72:310-315. [PMID: 31492482 DOI: 10.1016/j.jocn.2019.08.117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 08/25/2019] [Indexed: 10/26/2022]
Abstract
Presently, disparities exist between race, sex, socioeconomic status, hospitals, income, comorbidities, and insurance profiles of patients undergoing DBS surgery. Here, we aim to highlight several variables and their predictive powers of DBS surgery outcomes as measured by dischargelocation, length of hospital stays, and total hospital charges. A retrospective cohort study using discharge data from NIS and HCUP for analyses and regression model statistics is performed. Comparative analyses demonstrate urban patients were more often non-routinely discharged, possessed private insurance, and accrued greater hospital costs compared to rural patients. Moreover, regression analyses predicts urban patients have 70% lower odds of routine discharge while those with a major loss of function prior to surgery also have 81% lower odds of routine discharge compared to those with minor loss of function. Ultimately, our study found urban patients or patients with major illnesses have higher hospital charges, longer hospitalization, and more often non-routinely discharged.
Collapse
Affiliation(s)
- Michael Fana
- Central Michigan University College of Medicine, Mount Pleasant, MI, USA.
| | - Gregory Everett
- Central Michigan University College of Medicine, Mount Pleasant, MI, USA
| | - Thomas Fagan
- Central Michigan University College of Medicine, Mount Pleasant, MI, USA
| | - Megan Mazzella
- Central Michigan University College of Medicine, Mount Pleasant, MI, USA
| | - Sulmaz Zahedi
- Central Michigan University College of Medicine, Mount Pleasant, MI, USA
| | - John M Clements
- Michigan State University, Division of Public Health, College of Human Medicine, Flint, MI, USA
| |
Collapse
|
13
|
Yoon JS, Tang OY, Lawton MT. Volume–Cost Relationship in Neurosurgery: Analysis of 12,129,029 Admissions from the National Inpatient Sample. World Neurosurg 2019; 129:e791-e802. [DOI: 10.1016/j.wneu.2019.06.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/03/2019] [Accepted: 06/03/2019] [Indexed: 10/26/2022]
|
14
|
Goshtasbi K, Abouzari M, Moshtaghi O, Sahyouni R, Sajjadi A, Lin HW, Djalilian HR. The changing landscape of vestibular schwannoma diagnosis and management: A cross-sectional study. Laryngoscope 2019; 130:482-486. [PMID: 30953401 DOI: 10.1002/lary.27950] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/05/2019] [Accepted: 03/06/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To assess the current state of the diagnosis and management of vestibular schwannoma (VS) as well as treatment trends, and to evaluate the role of treatment setting and various specialists in treatment plan. METHODS Patients diagnosed with VS completed a voluntary and anonymous survey. The questionnaires were distributed through Acoustic Neuroma Association website, Facebook page, and e-mail newsletters from January to March 2017. RESULTS In total, 789 VS patients completed the survey. Of those, 414 (52%) underwent surgery; 224 (28%) underwent radiotherapy; and 121 (15%) were observed. General otolaryngologists diagnosed 62% of responders, followed by primary care (11%) and neurotologists (10%). Patients who underwent surgery were significantly younger and had larger tumors compared to those treated with radiation or observation. The ratio of patients having nonsurgical versus surgical resection changed from 1:2 to 1:1 for the periods of 1979 through 2006 versus 2007 through 2017, respectively. Neurosurgeons (40%) and neurotologists (38%) were the most influential in treatment discussion. Neurotologists (P < 0.001) and general otolaryngologists (P = 0.04) were more influential than neurosurgeons for the decision process in patients with smaller tumors. Patients treated at academic versus nonacademic private institutions reported similar tumor sizes (P = 0.27), treatment decisions (P = 0.09), and decision satisfaction (P = 0.78). CONCLUSION There is a continuing trend toward nonsurgical management, with approximately half of the patients opting for nonsurgical management. In this cohort, the patients commonly presented with otologic symptoms and otolaryngologists made the most diagnoses. Neurotologists and neurosurgeons were the most influential in treatment discussion. LEVEL OF EVIDENCE NA Laryngoscope, 130:482-486, 2020.
Collapse
Affiliation(s)
- Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, U.S.A
| | - Mehdi Abouzari
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, U.S.A
| | - Omid Moshtaghi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, U.S.A
| | - Ronald Sahyouni
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, U.S.A.,Department of Biomedical Engineering, University of California, Irvine, Irvine, California, U.S.A
| | - Autefeh Sajjadi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, U.S.A
| | - Harrison W Lin
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, U.S.A
| | - Hamid R Djalilian
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, U.S.A.,Department of Biomedical Engineering, University of California, Irvine, Irvine, California, U.S.A
| |
Collapse
|
15
|
Zhao B, Tyree GA, Lin TC, Vaida F, Stock BJ, Hamelin TA, Clary BM. Effects of a Surgical Receipt Program on the Supply Costs of Five General Surgery Procedures. J Surg Res 2018; 236:110-118. [PMID: 30694743 DOI: 10.1016/j.jss.2018.11.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/27/2018] [Accepted: 11/19/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Surgical supplies occupy a large portion of health care expenditures but is often under the surgeon's control. We sought to assess whether an automated, surgeon-directed, cost feedback system can decrease supply expenditures for five common general surgery procedures. MATERIALS AND METHODS An automated "surgical receipt" detailing intraoperative supply costs was generated and emailed to surgeons after each case. We compared the median cost per case for 18 mo before and after implementation of the surgical receipt. We controlled for price fluctuations by applying common per-unit prices in both periods. We also compared the incision time, case length booking accuracy, length of stay, and postoperative occurrences. RESULTS Median costs decreased significantly for open inguinal hernia ($433.45 to $385.49, P < 0.001), laparoscopic cholecystectomy ($886.77 to $816.13, P = 0.002), and thyroidectomy ($861.21 to $825.90, P = 0.034). Median costs were unchanged for laparoscopic appendectomy and increased significantly for lumpectomy ($325.67 to $420.53, P < 0.001). There was an increase in incision-to-closure minutes for open inguinal hernia (71 to 75 min, P < 0.001) and laparoscopic cholecystectomy (75 to 96 min, P < 0.001), but a decrease in thyroidectomy (79 to 73 min, P < 0.001). There was an increase in booking accuracy for laparoscopic appendectomy (38.6% to 55.0%, P = 0.001) and thyroidectomy (32.5% to 48.1%, P = 0.001). There were no differences in postoperative occurrence rates and length of stay duration. CONCLUSIONS An automated surgeon-directed surgical receipt may be a useful tool to decrease supply costs for certain procedures. However, curtailing surgical supply costs with surgeon-directed cost feedback alone is challenging and a multimodal approach may be necessary.
Collapse
Affiliation(s)
- Beiqun Zhao
- Department of Surgery, University of California San Diego, La Jolla, California.
| | - Griffin A Tyree
- School of Medicine, University of California San Diego, La Jolla, California
| | - Timothy C Lin
- School of Medicine, University of California San Diego, La Jolla, California
| | - Florin Vaida
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla, California
| | - Blake J Stock
- Surgery, Anesthesiology, Musculoskeletal, Neurology, and Imaging Services, University of California San Diego, San Diego, California
| | - Thomas A Hamelin
- Surgery, Anesthesiology, Musculoskeletal, Neurology, and Imaging Services, University of California San Diego, San Diego, California
| | - Bryan M Clary
- Department of Surgery, University of California San Diego, La Jolla, California
| |
Collapse
|
16
|
Buchlak QD, Kowalczyk M, Leveque JC, Wright A, Farrokhi F. Risk stratification in deep brain stimulation surgery: Development of an algorithm to predict patient discharge disposition with 91.9% accuracy. J Clin Neurosci 2018; 57:26-32. [DOI: 10.1016/j.jocn.2018.08.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 08/12/2018] [Accepted: 08/21/2018] [Indexed: 01/25/2023]
|
17
|
Yin Z, Cao Y, Zheng S, Duan J, Zhou D, Xu R, Hong T, Lu G. Persistent adverse effects following different targets and periods after bilateral deep brain stimulation in patients with Parkinson's disease. J Neurol Sci 2018; 393:116-127. [DOI: 10.1016/j.jns.2018.08.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 06/22/2018] [Accepted: 08/14/2018] [Indexed: 02/04/2023]
|
18
|
Rumalla K, Smith KA, Follett KA, Nazzaro JM, Arnold PM. Rates, causes, risk factors, and outcomes of readmission following deep brain stimulation for movement disorders: Analysis of the U.S. Nationwide Readmissions Database. Clin Neurol Neurosurg 2018; 171:129-134. [DOI: 10.1016/j.clineuro.2018.06.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 05/28/2018] [Accepted: 06/09/2018] [Indexed: 12/21/2022]
|
19
|
Piazza M, Sharma N, Osiemo B, McClintock S, Missimer E, Gardiner D, Maloney E, Callahan D, Smith JL, Welch W, Schuster J, Grady MS, Malhotra NR. Initial Assessment of the Risk Assessment and Prediction Tool in a Heterogeneous Neurosurgical Patient Population. Neurosurgery 2018; 85:50-57. [DOI: 10.1093/neuros/nyy197] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 04/13/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Matthew Piazza
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsy-lvania
| | - Nikhil Sharma
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsy-lvania
| | - Benjamin Osiemo
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsy-lvania
- Department of Mathematics, Westchester University, Westchester, Pennsylvania
| | - Scott McClintock
- Department of Mathematics, Westchester University, Westchester, Pennsylvania
| | - Emily Missimer
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsy-lvania
| | - Diana Gardiner
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsy-lvania
| | - Eileen Maloney
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsy-lvania
| | - Danielle Callahan
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsy-lvania
| | - J Lachlan Smith
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsy-lvania
| | - William Welch
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsy-lvania
| | - James Schuster
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsy-lvania
| | - M Sean Grady
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsy-lvania
| | - Neil R Malhotra
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsy-lvania
| |
Collapse
|
20
|
Mukherjee K, Kamal KM. Impact of atrial fibrillation on inpatient cost for ischemic stroke in the USA. Int J Stroke 2018; 14:159-166. [DOI: 10.1177/1747493018765491] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Atrial fibrillation is a significant risk factor for ischemic stroke and increases cost of treatment. Aims To estimate the incremental inpatient cost and length of stay due to atrial fibrillation among adults hospitalized with a primary diagnosis of ischemic stroke after controlling for sociodemographic, clinical, and hospital characteristics in a nationally representative discharge record of US population. Methods Hospital discharge records with a primary diagnosis of ischemic stroke were identified from the National Inpatient Sample data for the years 2010–2013. Generalized linear model with log link and least-square means were utilized to estimate the incremental inpatient cost and length of stay in ischemic stroke due to atrial fibrillation after controlling for sociodemographic, clinical, and hospital characteristics. Results Among 434,544 hospital discharge records with a primary diagnosis of ischemic stroke, 90,190 (20.76%) discharge records had a secondary diagnosis of atrial fibrillation. The average inpatient cost for all discharge records with a primary diagnosis of ischemic stroke was (mean = $13,072, median = $9270.87) significantly (p < 0.0001) higher compared to all discharge records without ischemic stroke (mean = $12,543.07, median = $7517.13). The mean length of stay for all records was 4.55 days (95% CI = 4.53–4.56). Among those identified with ischemic stroke, adjusted mean inpatient cost was higher by $2829 (95% CI = $2708–$2949) and mean length of stay was greater by 0.85 (95% CI = 0.81–0.89) for those with atrial fibrillation compared to those without. Conclusions The presence of atrial fibrillation was associated with increased inpatient cost and length of stay among patients diagnosed with ischemic stroke. Increased inpatient cost and length of stay call for a more comprehensive patient care approach including targeted interventions among adults diagnosed with ischemic stroke and atrial fibrillation, which could potentially reduce the overall cost in this population.
Collapse
Affiliation(s)
- Kumar Mukherjee
- Philadelphia College of Osteopathic Medicine School of Pharmacy, Suwanee, USA
| | - Khalid M Kamal
- Division of Pharmaceutical, Administrative and Social Sciences, Duquesne University School of Pharmacy, Pittsburgh, USA
| |
Collapse
|
21
|
Oravec CS, Motiwala M, Reed K, Kondziolka D, Barker FG, Michael LM, Klimo P. Big Data Research in Neurosurgery: A Critical Look at this Popular New Study Design. Neurosurgery 2017; 82:728-746. [DOI: 10.1093/neuros/nyx328] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 05/17/2017] [Indexed: 01/10/2023] Open
Affiliation(s)
- Chesney S Oravec
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Mustafa Motiwala
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Kevin Reed
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Douglas Kondziolka
- Department of Neurosurgery, New York University Langone Medical Center, New York, New York
| | - Fred G Barker
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
- Semmes Murphey Clinic, Memphis, Tennessee
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
- Semmes Murphey Clinic, Memphis, Tennessee
- Department of Neurosurgery, Le Bonheur Children's Hospital, Memphis, Tennessee
| |
Collapse
|
22
|
Iyer VN, Brinjikji W, Pannu BS, Apala DR, Lanzino G, Cloft HJ, Misra S, Krowka MJ, Wood CP, Swanson KL. Effect of Center Volume on Outcomes in Hospitalized Patients With Hereditary Hemorrhagic Telangiectasia. Mayo Clin Proc 2016; 91:1753-1760. [PMID: 27814895 DOI: 10.1016/j.mayocp.2016.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 06/11/2016] [Accepted: 07/06/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine whether hospitalized patients with hereditary hemorrhagic telangiectasia (HHT) had better outcomes at high-volume treatment centers (HVCs). PATIENTS AND METHODS The Nationwide Inpatient Sample (2000-2011) was used to identify HHT-related hospitalizations. Hospitals were classified based on quartiles of annual HHT discharge volume. The 75th percentile cutoff value (third quartile) was used to classify hospitals as low-volume centers (1-7 HHT discharges per year) or as HVCs (≥8 discharges per year. Demographic features, complication rates, and outcomes were compared between the 2 groups. RESULTS We identified 9440 hospital discharges in patients with HHT. Of these patients, 6856 (72.6%) were admitted to low-volume centers and 2584 (27.4%) to HVCs. The former were more likely to be of white race, older, and with higher income levels (P<.001 for each). The HVCs had higher rates of anemia, epistaxis, congestive heart failure, pulmonary hypertension, and cerebral and pulmonary arteriovenous malformations and lower rates of ischemic stroke and myocardial infarction. After adjusting for baseline differences in a multivariate model, patients treated at HVCs were more likely to be discharged home (odds ratio [OR]=1.35; 95% CI, 1.21-1.52; P<.001) and less likely to be discharged to short-term rehabilitation facilities (OR=0.45; 95% CI, 0.31-0.64; P<.001). Patients treated at HVCs also had a significantly lower risk of in-hospital mortality (OR=0.51; 95% CI, 0.34-0.74; P<.001). CONCLUSION Patients with HHT hospitalized at HVCs had better outcomes, with lower in-hospital mortality and higher home discharge rates. These findings strongly support ongoing efforts to expand access to HHT centers of excellence in the United States and worldwide.
Collapse
Affiliation(s)
- Vivek N Iyer
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
| | | | - Bibek S Pannu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Dinesh R Apala
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | | | | | - Sanjay Misra
- Department of Radiology, Mayo Clinic, Rochester, MN
| | - Michael J Krowka
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | | | - Karen L Swanson
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Scottsdale, AZ
| |
Collapse
|
23
|
Hu K, Moses ZB, Hutter MM, Williams Z. Short-Term Adverse Outcomes After Deep Brain Stimulation Treatment in Patients with Parkinson Disease. World Neurosurg 2016; 98:365-374. [PMID: 27826085 DOI: 10.1016/j.wneu.2016.10.138] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 10/26/2016] [Accepted: 10/28/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Despite ongoing progress in our understanding of long-term outcomes after neuromodulation procedures, acute adverse outcomes shortly after deep brain stimulation (DBS) treatment have remained remarkably limited. OBJECTIVE To identify risk factors associated with acute 30-day outcomes after DBS treatment in patients with Parkinson disease (PD). METHODS We evaluated patients who underwent DBS treatment for PD from 2005 to 2014 through the American College of Surgeons National Surgical Quality Improvement Program database. We used bivariate analysis and multivariate logistic regression to identify short-term postoperative outcomes, including 30-day complication, discharge destination, and unplanned readmission. RESULTS Overall, 650 patients with PD underwent DBS procedures and complications were identified in 32 patients (4.9%). Of 481 patients who had complete discharge data, 18 patients (3.7%) were discharged to a facility and 16 patients (3.3%) experienced an unplanned readmission. Patients with PD who were obese (P = 0.045), who had preoperative anemia (P = 0.008), and who experienced longer operative durations (P = 0.01) had increased odds of postoperative complications. Inpatient status (P = 0.001), dependent functional status (P < 0.001), and anemia (P = 0.043) were all associated with discharge to a facility other than home. Longer operative duration (P = 0.013), anemia (P = 0.036), and dependent functional status (P = 0.03) were significantly associated with unplanned readmission. As expected, complications increased the likelihood of unplanned readmission (P < 0.001). CONCLUSIONS This study provides individualized estimates of the risks associated with short-term adverse outcomes based on patient demographics and comorbidities. These data can be used as an adjunct for short-term risk stratification of patients with PD being considered for DBS treatment.
Collapse
Affiliation(s)
- Kejia Hu
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Microsurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Ziev B Moses
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew M Hutter
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ziv Williams
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| |
Collapse
|
24
|
Rolston JD, Englot DJ, Starr PA, Larson PS. An unexpectedly high rate of revisions and removals in deep brain stimulation surgery: Analysis of multiple databases. Parkinsonism Relat Disord 2016; 33:72-77. [PMID: 27645504 DOI: 10.1016/j.parkreldis.2016.09.014] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 09/07/2016] [Accepted: 09/12/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Deep brain stimulation (DBS) is an established therapy for movement disorders, and is under active investigation for other neurologic and psychiatric indications. While many studies describe outcomes and complications related to stimulation therapies, the majority of these are from large academic centers, and results may differ from those in general neurosurgical practice. METHODS Using data from both the Centers for Medicare and Medicaid Services (CMS) and the National Surgical Quality Improvement Program (NSQIP), we identified all DBS procedures related to primary placement, revision, or removal of intracranial electrodes. Cases of cortical stimulation and stimulation for epilepsy were excluded. RESULTS Over 28,000 cases of DBS electrode placement, revision, and removal were identified during the years 2004-2013. In the Medicare dataset, 15.2% and of these procedures were for intracranial electrode revision or removal, compared to 34.0% in the NSQIP dataset. In NSQIP, significant predictors of revision and removal were decreased age (odds ratio (OR) of 0.96; 95% CI: 0.94, 0.98) and higher ASA classification (OR 2.41; 95% CI: 1.22, 4.75). Up to 48.5% of revisions may have been due to improper targeting or lack of therapeutic effect. CONCLUSION Data from multiple North American databases suggest that intracranial neurostimulation therapies have a rate of revision and removal higher than previously reported, between 15.2 and 34.0%. While there are many limitations to registry-based studies, there is a clear need to better track and understand the true prevalence and nature of such failures as they occur in the wider surgical community.
Collapse
Affiliation(s)
- John D Rolston
- Department of Neurological Surgery, University of California, San Francisco, United States.
| | - Dario J Englot
- Department of Neurological Surgery, University of California, San Francisco, United States
| | - Philip A Starr
- Department of Neurological Surgery, University of California, San Francisco, United States
| | - Paul S Larson
- Department of Neurological Surgery, University of California, San Francisco, United States
| |
Collapse
|
25
|
Zygourakis CC, Valencia V, Boscardin C, Nayak RU, Moriates C, Gonzales R, Theodosopoulos P, Lawton MT. Predictors of Variation in Neurosurgical Supply Costs and Outcomes Across 4904 Surgeries at a Single Institution. World Neurosurg 2016; 96:177-183. [PMID: 27613498 DOI: 10.1016/j.wneu.2016.08.121] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 08/27/2016] [Accepted: 08/30/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is high variability in neurosurgical costs, and surgical supplies constitute a significant portion of cost. Anecdotally, surgeons use different supplies for various reasons, but there is little understanding of how supply choices affect outcomes. Our goal is to evaluate the effect of patient, procedural, and provider factors on supply cost and to determine if supply cost is associated with patient outcomes. METHODS We obtained patient information (age, gender, payor, case mix index [CMI], body mass index, admission source), procedural data (procedure type, length, date), provider information (name, case volume), and total surgical supply cost for all inpatient neurosurgical procedures from 2013 to 2014 at our institution (n = 4904). We created mixed-effect models to examine the effect of each factor on surgical supply cost, 30-day readmission, and 30-day mortality. RESULTS There was significant variation in surgical supply cost between and within procedure types. Older age, female gender, higher CMI, routine/elective admission, longer procedure, and larger surgeon volume were associated with higher surgical supply costs (P < 0.05). Routine/elective admission and higher surgeon volume were associated with lower readmission rates (odds ratio, 0.707, 0.998; P < 0.01). Only patient factors of older age, male gender, private insurance, higher CMI, and emergency admission were associated with higher mortality (odds ratio, 1.029, 1.700, 1.692, 1.080, 2.809). There was no association between surgical supply cost and readmission or mortality (P = 0.307, 0.548). CONCLUSIONS A combination of patient, procedural, and provider factors underlie the significant variation in neurosurgical supply costs at our institution. Surgical supply costs are not correlated with 30-day readmission or mortality.
Collapse
Affiliation(s)
- Corinna C Zygourakis
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA; Center for Healthcare Value, University of California, San Francisco, San Francisco, California, USA.
| | - Victoria Valencia
- Center for Healthcare Value, University of California, San Francisco, San Francisco, California, USA; Department of Medicine, University of California, San Francisco, San Francisco, California, USA; Department of Medicine, Dell Medical School at the University of Texas at Austin, Austin, Texas, USA
| | - Christy Boscardin
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Rahul U Nayak
- Center for Healthcare Value, University of California, San Francisco, San Francisco, California, USA
| | - Christopher Moriates
- Center for Healthcare Value, University of California, San Francisco, San Francisco, California, USA; Department of Medicine, University of California, San Francisco, San Francisco, California, USA; Department of Medicine, Dell Medical School at the University of Texas at Austin, Austin, Texas, USA
| | - Ralph Gonzales
- Center for Healthcare Value, University of California, San Francisco, San Francisco, California, USA; Department of Medicine, University of California, San Francisco, San Francisco, California, USA; Continuous Process Improvement Department, UCSF Health, San Francisco, California, USA
| | - Philip Theodosopoulos
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Michael T Lawton
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| |
Collapse
|
26
|
Sharma M, Deogaonkar M. Accuracy and safety of targeting using intraoperative “O-arm” during placement of deep brain stimulation electrodes without electrophysiological recordings. J Clin Neurosci 2016; 27:80-6. [DOI: 10.1016/j.jocn.2015.06.036] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 06/16/2015] [Accepted: 06/20/2015] [Indexed: 10/22/2022]
|
27
|
Incidence, hospital costs and in-hospital mortality rates of epidural hematoma in the United States. Clin Neurol Neurosurg 2015; 138:99-103. [DOI: 10.1016/j.clineuro.2015.07.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 07/22/2015] [Accepted: 07/24/2015] [Indexed: 11/19/2022]
|
28
|
Michael LM, Klimo P. Outcomes Research in Neurosurgery: Do Administrative Databases Hold the Answers? World Neurosurg 2015; 84:1193-5. [DOI: 10.1016/j.wneu.2015.06.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 06/24/2015] [Indexed: 11/26/2022]
|
29
|
Abstract
For a variety of neurosurgical conditions, increasing surgeon and hospital volumes correlate with improved outcomes, such as mortality, complication rates, length of stay, hospital charges, and discharge disposition. Neurosurgeons can improve patient outcomes at the population level by changing practice and referral patterns to regionalize care for select conditions at high-volume specialty treatment centers. Individual practitioners should be aware of where they fall on the volume spectrum and understand the implications of their practice and referral habits on their patients.
Collapse
|