Short-term 30-day adverse events following awake versus asleep deep brain stimulation for movement disorders: a nationwide registry-based study

Abstract

Introduction: Deep Brain Stimulation (DBS) is FDA-approved for the management of medically refractory movement disorders and epilepsy. We aim to assess potential differences in adverse eventsamong patients undergoing asleep versus awake DBS, to facilitate a patient centric decision-making process for the selection of ideal anesthesia modality for individuals undergoing DBS procedures.

Methods: The ACS National Surgical Quality Improvement Program (NSQIP) database was queried for all patients undergoing DBS treatment between 2011 and 2020 in patients with a diagnosis of Parkinson's Disease, and Essential Tremor. Propensity score matching in a 2:1 ratio was performed. The primary endpoint was to quantify any short-term adverse events.

Results: In total, 1778 patients undergoing asleep (75.7 %) and awake DBS procedures (24.3 %) were identified. The median age among included was 68.0 with most being males (65 %). After 2:1 propensity score matching there was no remaining baseline difference. 30-day complication rates were comparable between groups (2.3 % asleep vs. 0.7 % awake; p = 0.062). Similarly, there were no significant differences in 30-day readmission (3.5 % vs. 3.5 %; p = 0.96), reoperation (1.4 % vs. 0.9 %; p = 0.48), or non-home discharge (3.5 % vs. 3.0 %; p = 0.63). Median hospital length of stay did not differ significantly (0 vs. 0 days; p = 0.23).

Conclusion: In this matched analysis using data from a prospective multicenter database of U.S. hospitals, asleep and awake DBS demonstrated comparable 30-day outcomes. No significant differences were observed in complication rates, readmissions, reoperations, discharge disposition, or length of hospital stay. These findings support clinical equipoise between the two approaches and underscore the importance of tailoring the choice of technique to individual patient characteristics and preferences.

Keywords: Asleep; Awake; Deep brain stimulation; General anesthesia; Local anesthesia.

Fig. 1

Love plots demonstrating the performance of the matching process. Each point represents the standardized mean difference of a covariate between our two groups, before and after adjustment.