caution is paramount
D Valente, MD
However, care must be taken when selecting older patients as surgical candidates.
Since the introduction of deep brain stimulation (DBS), outcomes have continued to improve. However concern has been increasing about safety, especially in older patients. In this study, researchers carefully evaluated the effect of increasing age on short-term complications of DBS for Parkinson disease (PD) in a retrospective analysis using the Thomson Reuters MarketScan national database. The database included 1757 patients who underwent DBS for PD over a 9-year period. The study focused on the length of hospital stay and on complications reported within 90 days after DBS surgery.
A total of 132 patients (7.5%) experienced at least one complication in the 90-day window. The most common complications included infections (3.6%), pneumonia (2.3%), hemorrhage or hematoma (1.4%), and pulmonary embolism (0.6%). Mortality was 0.2% in those aged 75 or younger and 1.6% in older patients. Multivariate logistic regression analysis showed that the complication rate (including hemorrhage and infection) did not increase significantly with age.
Although the authors report that patients older than 75 and younger patients had similar 90-day complication rates, groups performing DBS surgery should not misinterpret the study to mean it is always safe to operate on older patients with PD. Patients older than 75 are at increased risk for complications from any noncardiac surgery (J Am Geriatr Soc 2005; 53:424). The small number of patients reporting a single complication at 90 days in this study suggests substantial underreporting, which is a bias inherent to a retrospective analysis. Additionally, the older patients likely underwent more-rigorous screening and management, but again this cannot be uncovered from the methods used. The bottom line for DBS centers screening potential candidates is to not automatically exclude elderly patients. Multidisciplinary DBS evaluation and discussion has proven essential to the success of surgery, especially when considering an intervention in the elderly PD patient. Follow-up to detect outcomes and complications from device interventions will require more than a 90-day interval to judge success and failure.
Disclosures for Michael S. Okun, MD at time of publication Grant / Research support NIH; National Parkinson Foundation; Michael J. Fox Foundation; Tourette Syndrome Association; Bachmann-Strauss; Dystonia Medical Research Foundation Editorial boards National Parkinson Foundation; Parkinsonism and Related Disorders; Tremor and Hyperkinetic Disorders Leadership positions in professional societies National Parkinson Foundation (National Medical Director); Tourette Syndrome Association (Co-Chair Medical Advisory Board); The International Parkinson and Movement Disorder Society (International Executive Committee)