DBS Improves Inpatient Outcomes for Comorbid Parkinson Disease and Depression
Commonly occurring with Parkinson disease, major depressive disorder can lead to poor outcomes in hospitalized patients.
|The following article is part of conference coverage from the 2018 American Academy of Neurology Annual Meeting in Los Angeles, California. Neurology Advisor's staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from AAN 2018.|
LOS ANGELES — Deep brain stimulation (DBS) was found to significantly improve hospital and related outcomes for patients with comorbid Parkinson disease and major depressive disorder, according to research presented at the 70th annual American Academy of Neurology meeting, held April 21-27, 2018, in Los Angeles, California. Major depressive disorder is a common Parkinson disease comorbidity that both worsens a patient's symptom burden and leads to negative hospital and related outcomes. The impact of DBS on these outcomes has not been previously studied.
Using validated International Classification of Diseases, 9th Revision Clinical Modification codes, study investigators analyzed data from the 2010-2014 Nationwide Inpatient Sample, identifying Parkinson disease as a primary diagnosis, major depressive disorder as an other diagnosis, and deep brain stimulation as a primary procedure. Adjusted odds ratios (aOR) were generated using binomial logistic regression.
To determine the impact of DBS on inpatient outcomes for patients with comorbid Parkinson disease and major depressive disorder, inpatient admissions of 1037 individuals with these diagnoses were analyzed. Of these, 6.8% (n=70) underwent DBS, which was shown to result in a significantly decreased mean length of hospitalization (1.7 vs 6.1 days; P<.001) and a 1.58-times reduced risk for >4 days (median) inpatient stay (aOR 0.205; 95% CI, 0.108-0.389; P<.001). A 1.65-times decreased risk for major loss of body function was also seen in patients following DBS (aOR 0.192; 95% CI, 0.075-0.491; P=.001), as was a significantly decreased rate of inpatient mortality (0% vs 2.1%; P<.001).
Treatment with DBS was associated with higher hospitalization costs ($54,849 vs $29,707; P<.001) and a 1.47-times greater risk for median inpatient charges >$21,610 (aOR 4.338; 95% CI, 2.168-8.682; P<.001). Patients undergoing DBS also had significantly lower rates of transfer to acute care hospitals or skilled nursing facilities (0% and 7.1% vs 4% and 56.6%; P<.001).
The study investigators concluded that because DBS significantly improved inpatient outcomes by decreasing morbidity and mortality, and by reducing transfers to acute care and nursing facilities as well as length of hospitalization, “Patients with comorbid Parkinson's disease and major depressive disorder deserve greater consideration for deep brain stimulation in multi-disciplinary team setting involving psychiatrists to optimize patient selection and safety.”
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Patel R, Chopra A. Impact of deep brain stimulation on hospital and related outcomes in patients with comorbid Parkinson's disease and major depressive disorder: a nationwide inpatient sample study. Poster presented at: 2018 AAN Annual Meeting; April 21-27, 2018; Los Angeles, CA. Poster 70.