Impact of Hospital Volume Status on Postoperative Outcomes and Cost following Deep Brain Stimulation for Movement Disorders.

IF 2.1 4区医学 Q3 NEUROIMAGING

Stereotactic and Functional Neurosurgery Pub Date : 2026-03-02 DOI:10.1159/000551148

Stefan T Prvulovic, Omar Sbaih, Michael M Covell, Ryan Gensler, Shubhang Bhalla, Andre A Payman, Tyler Zeoli, Joanna M Roy, Christian A Bowers

{"title":"Impact of Hospital Volume Status on Postoperative Outcomes and Cost following Deep Brain Stimulation for Movement Disorders.","authors":"Stefan T Prvulovic, Omar Sbaih, Michael M Covell, Ryan Gensler, Shubhang Bhalla, Andre A Payman, Tyler Zeoli, Joanna M Roy, Christian A Bowers","doi":"10.1159/000551148","DOIUrl":null,"url":null,"abstract":"Introduction: Deep brain stimulation (DBS) has emerged as a transformative neurosurgical intervention for refractory movement disorders, including Parkinson's disease (PD), essential tremor (ET), and dystonia. While clinical efficacy is well established, significant variability exists in procedural outcomes across hospitals. This nationwide study investigated the impact of hospital procedural volume on short-term postoperative outcomes and cost following DBS across 234 US hospitals from 2015 to 2020.Methods: We conducted a retrospective analysis of 6,964 DBS procedures (2015-2020) using the Nationwide Inpatient Sample. Hospitals were categorized by 6-year DBS volume: high-volume centers (HVCs, ≥450), medium-volume (50-449), and low-volume (<50). Multivariable regression assessed outcomes, including prolonged length of stay (pLOS >75th percentile), nonroutine discharge (NRD), high charge (>90th percentile), and complications, controlling for patient demographics, comorbidities, and hospital characteristics.Results: HVCs showed superior outcomes compared with low-volume centers, with lower rates of pLOS (4.1% vs. 8.9%, p < 0.001), high charges (6.7% vs. 15.3%, p < 0.001), and NRD (11.0% vs. 16.5%, p < 0.001). PD patients had 45% greater odds of pLOS (OR = 1.45, 95% CI: 1.12-1.88, p = 0.004) but 36% lower odds of NRD (OR = 0.64, 95% CI: 0.49-0.83, p = 0.001) compared with ET patients. Dystonia patients had 2.4 times higher odds of pLOS (OR = 2.39, 95% CI: 1.76-3.25, p < 0.001) and 65% higher odds of incurring high charges (OR = 1.65, 95% CI: 1.22-2.23, p = 0.001). In multivariate models, HVCs were significantly associated with reduced risk of NRD, high charge, and pLOS.Conclusion: Despite a 6% decline in DBS volume due to fewer PD cases, inflation-adjusted charges rose >30% across centers. The volume-outcome relationship persists, with HVCs showing better efficiency but challenges in discharge disposition, highlighting the need for standardized care pathways for dystonia and closer evaluation of socioeconomic barriers to DBS access and outcomes.","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-15"},"PeriodicalIF":2.1000,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Stereotactic and Functional Neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000551148","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"NEUROIMAGING","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction: Deep brain stimulation (DBS) has emerged as a transformative neurosurgical intervention for refractory movement disorders, including Parkinson's disease (PD), essential tremor (ET), and dystonia. While clinical efficacy is well established, significant variability exists in procedural outcomes across hospitals. This nationwide study investigated the impact of hospital procedural volume on short-term postoperative outcomes and cost following DBS across 234 US hospitals from 2015 to 2020.

Methods: We conducted a retrospective analysis of 6,964 DBS procedures (2015-2020) using the Nationwide Inpatient Sample. Hospitals were categorized by 6-year DBS volume: high-volume centers (HVCs, ≥450), medium-volume (50-449), and low-volume (<50). Multivariable regression assessed outcomes, including prolonged length of stay (pLOS >75th percentile), nonroutine discharge (NRD), high charge (>90th percentile), and complications, controlling for patient demographics, comorbidities, and hospital characteristics.

Results: HVCs showed superior outcomes compared with low-volume centers, with lower rates of pLOS (4.1% vs. 8.9%, p < 0.001), high charges (6.7% vs. 15.3%, p < 0.001), and NRD (11.0% vs. 16.5%, p < 0.001). PD patients had 45% greater odds of pLOS (OR = 1.45, 95% CI: 1.12-1.88, p = 0.004) but 36% lower odds of NRD (OR = 0.64, 95% CI: 0.49-0.83, p = 0.001) compared with ET patients. Dystonia patients had 2.4 times higher odds of pLOS (OR = 2.39, 95% CI: 1.76-3.25, p < 0.001) and 65% higher odds of incurring high charges (OR = 1.65, 95% CI: 1.22-2.23, p = 0.001). In multivariate models, HVCs were significantly associated with reduced risk of NRD, high charge, and pLOS.

Conclusion: Despite a 6% decline in DBS volume due to fewer PD cases, inflation-adjusted charges rose >30% across centers. The volume-outcome relationship persists, with HVCs showing better efficiency but challenges in discharge disposition, highlighting the need for standardized care pathways for dystonia and closer evaluation of socioeconomic barriers to DBS access and outcomes.

查看原文本刊更多论文

医院容量状况对脑深部电刺激治疗运动障碍术后疗效和成本的影响

背景和目的脑深部电刺激（DBS）已成为一种变革性神经外科干预难治性运动障碍，包括帕金森病（PD）、特发性震颤（ET）和肌张力障碍。虽然临床疗效是公认的，但各医院的手术结果存在显著差异。这项全国性的研究调查了2015-2020年期间美国234家医院的医院手术量对DBS术后短期结果和成本的影响。方法采用全国住院患者样本对6964例DBS手术（2015-2020年）进行回顾性分析。医院按6年DBS容量分类：高容量中心（hvc,≥450）、中等容量中心（50-449）和低容量中心（第75百分位数）、非正常出院（NRD）、高收费（bbb90百分位数）和并发症，控制了患者人口统计学、合并症和医院特征。结果与小容量中心相比，hvc显示出更好的结果，pLOS的发生率较低（4.1%对8.9%，各中心的发生率为30%）。容量与结果的关系仍然存在，hvc显示出更好的效率，但在出院处置方面存在挑战，突出了对肌张力障碍的标准化护理途径的需求，以及对DBS使用和结果的社会经济障碍的更密切评估。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Stereotactic and Functional Neurosurgery 医学-神经成像

CiteScore

3.80

自引率

0.00%

发文量

审稿时长

3 months

期刊介绍： ''Stereotactic and Functional Neurosurgery'' provides a single source for the reader to keep abreast of developments in the most rapidly advancing subspecialty within neurosurgery. Technological advances in computer-assisted surgery, robotics, imaging and neurophysiology are being applied to clinical problems with ever-increasing rapidity in stereotaxis more than any other field, providing opportunities for new approaches to surgical and radiotherapeutic management of diseases of the brain, spinal cord, and spine. Issues feature advances in the use of deep-brain stimulation, imaging-guided techniques in stereotactic biopsy and craniotomy, stereotactic radiosurgery, and stereotactically implanted and guided radiotherapeutics and biologicals in the treatment of functional and movement disorders, brain tumors, and other diseases of the brain. Background information from basic science laboratories related to such clinical advances provides the reader with an overall perspective of this field. Proceedings and abstracts from many of the key international meetings furnish an overview of this specialty available nowhere else. ''Stereotactic and Functional Neurosurgery'' meets the information needs of both investigators and clinicians in this rapidly advancing field.