Surgery for Parkinson disease in the United States, 1996 to 2000

Practice patterns, short-term outcomes, and hospital charges in a nationwide sample

Emad N. Eskandar, Alice Flaherty, G. Rees Cosgrove, Leslie A. Shinobu, Fred G. Barker

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Object. The surgical treatment of Parkinson disease (PD) has undergone a dramatic shift, from stereotactic ablative procedures toward deep brain stimulaion (DBS). The authors studied this process by investigating practice patterns, mortality and morbidity rates, and hospital charges as reflected in the records of a representative sample of US hospitals between 1996 and 2000. Methods. The authors conducted a retrospective cohort study by using the Nationwide Inpatient Sample database; 1761 operations at 71 hospitals were studied. Projected to the US population, there were 1650 inpatient procedures performed for PD per year (pallidotomies, thalamotomies, and DBS), with no significant change in the annual number of procedures during the study period. The in-hospital mortality rate was 0.2%, discharge other than to home was 8. 1%, and the rate of neurological complications was 1.8%, with no significant differences between procedures. In multivariate analyses, hospitals with larger annual caseloads had lower mortality rates (p = 0.002) and better outcomes at hospital discharge (p = 0.007). Placement of deep brain stimulators comprised 0% of operations in 1996 and 88% in 2000. Factors predicting placement of these devices in analyses adjusted for year of surgery included younger age, Caucasian race, private insurance, residence in higher-income areas, hospital teaching status, and smaller annual hospital caseload. In multivariate analysis, total hospital charges were 2.2 times higher for DBS (median $36,000 compared with $12,000, p < 0.001), whereas charges were lower at higher-volume hospitals (p < 0.001). Conclusions. Surgical treatment of PD in the US changed significantly between 1996 and 2000. Larger-volume hospitals had superior short-term outcomes and lower charges. Future studies should address long-term functional end points, cost/benefit comparisons, and inequities in access to care.

Original languageEnglish (US)
Pages (from-to)863-871
Number of pages9
JournalJournal of Neurosurgery
Volume99
Issue number5
DOIs
StatePublished - Jan 1 2003
Externally publishedYes

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Hospital Charges
Parkinson Disease
Brain
Mortality
Inpatients
Multivariate Analysis
Pallidotomy
High-Volume Hospitals
Hospital Mortality
Insurance
Teaching Hospitals
Cost-Benefit Analysis
Cohort Studies
Retrospective Studies
Databases
Morbidity
Costs and Cost Analysis
Equipment and Supplies
Therapeutics
Population

Keywords

  • Deep brain stimulation
  • Hospital case volume
  • Outcome
  • Pallidotomy
  • Parkinson disease

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Surgery for Parkinson disease in the United States, 1996 to 2000 : Practice patterns, short-term outcomes, and hospital charges in a nationwide sample. / Eskandar, Emad N.; Flaherty, Alice; Cosgrove, G. Rees; Shinobu, Leslie A.; Barker, Fred G.

In: Journal of Neurosurgery, Vol. 99, No. 5, 01.01.2003, p. 863-871.

Research output: Contribution to journalArticle

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abstract = "Object. The surgical treatment of Parkinson disease (PD) has undergone a dramatic shift, from stereotactic ablative procedures toward deep brain stimulaion (DBS). The authors studied this process by investigating practice patterns, mortality and morbidity rates, and hospital charges as reflected in the records of a representative sample of US hospitals between 1996 and 2000. Methods. The authors conducted a retrospective cohort study by using the Nationwide Inpatient Sample database; 1761 operations at 71 hospitals were studied. Projected to the US population, there were 1650 inpatient procedures performed for PD per year (pallidotomies, thalamotomies, and DBS), with no significant change in the annual number of procedures during the study period. The in-hospital mortality rate was 0.2{\%}, discharge other than to home was 8. 1{\%}, and the rate of neurological complications was 1.8{\%}, with no significant differences between procedures. In multivariate analyses, hospitals with larger annual caseloads had lower mortality rates (p = 0.002) and better outcomes at hospital discharge (p = 0.007). Placement of deep brain stimulators comprised 0{\%} of operations in 1996 and 88{\%} in 2000. Factors predicting placement of these devices in analyses adjusted for year of surgery included younger age, Caucasian race, private insurance, residence in higher-income areas, hospital teaching status, and smaller annual hospital caseload. In multivariate analysis, total hospital charges were 2.2 times higher for DBS (median $36,000 compared with $12,000, p < 0.001), whereas charges were lower at higher-volume hospitals (p < 0.001). Conclusions. Surgical treatment of PD in the US changed significantly between 1996 and 2000. Larger-volume hospitals had superior short-term outcomes and lower charges. Future studies should address long-term functional end points, cost/benefit comparisons, and inequities in access to care.",
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AU - Flaherty, Alice

AU - Cosgrove, G. Rees

AU - Shinobu, Leslie A.

AU - Barker, Fred G.

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