Factors related to extended hospital stays following deep brain stimulation for Parkinson's disease

Mikos, Ania; Pavon, Juliessa; Bowers, Dawn; Foote, Kelly D.; Resnick, Andrew S.; Fernandez, Hubert H.; Thomas, Penelope; Garvan, Cynthia; Roy, Ananya; Okun, Michael S.

doi:10.1016/j.parkreldis.2010.02.002

« Previous Next »Parkinsonism & Related Disorders
Volume 16, Issue 5 , Pages 324-328, June 2010

Factors related to extended hospital stays following deep brain stimulation for Parkinson's disease☆

Ania Mikos
- Department of Clinical and Health Psychology, University of Florida, Movement Disorders Center, McKnight Brain Institute, Gainesville FL, USA
Juliessa Pavon
- Department of Neurology, University of Florida, Movement Disorders Center, McKnight Brain Institute, Gainesville FL, USA
- Department of Neurosurgery, University of Florida, Movement Disorders Center, McKnight Brain Institute, Gainesville FL, USA
- Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA
Dawn Bowers
- Department of Clinical and Health Psychology, University of Florida, Movement Disorders Center, McKnight Brain Institute, Gainesville FL, USA
Kelly D. Foote
- Department of Neurosurgery, University of Florida, Movement Disorders Center, McKnight Brain Institute, Gainesville FL, USA
Andrew S. Resnick
- Department of Neurology, University of Florida, Movement Disorders Center, McKnight Brain Institute, Gainesville FL, USA
Hubert H. Fernandez
- Department of Neurology, University of Florida, Movement Disorders Center, McKnight Brain Institute, Gainesville FL, USA
Penelope Thomas
- Department of Neurology, University of Florida, Movement Disorders Center, McKnight Brain Institute, Gainesville FL, USA
Cynthia Garvan
- College of Education, University of Florida, Gainesville, FL, USA
Ananya Roy
- Department of Statistics, University of Nebraska, Lincoln, NE, USA
Michael S. Okun
- Department of Neurology, University of Florida, Movement Disorders Center, McKnight Brain Institute, Gainesville FL, USA
- Department of Neurosurgery, University of Florida, Movement Disorders Center, McKnight Brain Institute, Gainesville FL, USA
- Corresponding author. Department of Neurology, University of Florida Movement Disorders Center 100 S Newell Dr. Room L3-101 Gainesville, FL 32611, USA. Tel.: +1 352 273 5550; fax: +1 352 273 5575.

Received 7 June 2009; received in revised form 2 January 2010; accepted 3 February 2010.

Abstract

Objective

Patients with Parkinson's disease (PD) are typically discharged from the hospital the day following deep brain stimulation (DBS) surgery; however, factors extending hospital stay are largely unknown. This study examined potential factors that might have corresponded to increased post-operative stays following unilateral DBS surgery.

Methods

A retrospective review was performed on 115 unilateral PD DBS patients. Age, gender, number of microelectrode passes, duration and severity of illness, and pre-operative neuropsychological scores were considered as possible contributors to length of stay.

Results

Most patients (79%) had a hospital stay of one day following surgery. The most frequent reasons for delayed discharge (>1 day) included mental status change (N = 6) and hemorrhage (N = 5). Those with delayed discharge had significantly lower pre-surgical cognitive screening scores (Mini-Mental State Evaluation; MMSE), higher pre-surgical “on” medication motor score, and more microelectrode passes than those with immediate discharge. In correlation analyses, increasing length of hospital stay was significantly associated with more microelectrode passes, higher pre-surgical “on” medication motor scores, and decreasing MMSE scores. When the significant variables from the preliminary analyses were entered into a Poisson regression model, a greater number of microelectrode passes as well as lower MMSE scores remained significant predictors of increased length of stay.

Conclusions

The number of microelectrode passes utilized for DBS surgery as well as a patient's general cognitive status may be important factors related to extended hospital stay. UPDRS “on” medication motor score may also provide some predictive power for immediate post-operative morbidity in unilateral DBS patients.

Keywords: Confusion, DBS, Management, Neuropsychological, Post-operative, Microelectrode recording