title: Changing practice patterns of deep brain stimulation in Parkinson's disease and essential tremor in the USA.
abstract: BACKGROUND
  Randomized controlled studies have shown deep brain stimulation (DBS) to be an effective treatment for Parkinson's disease (PD). Outside of large-center studies, little is known about trends in DBS use in the USA.
  
  
  OBJECTIVE
  We employ the Nationwide Inpatient Sample to look at changes in DBS utilization over time.
  
  
  METHODS
  We identified all individuals with PD (332.0) and essential tremor (ET) (333.1) who underwent DBS (02.93) from 1998 to 2007. We examined demographics, hospital status, comorbidities, and in-hospital systemic/technical complications. DBS patients from 2000 and 2007 were compared using χ(2) tests.
  
  
  RESULTS
  PD patients from the 2007 sample who underwent DBS were older (p = 0.01). Both ET and PD patients had significantly more comorbidities in 2007 (p < 0.001). In-hospital complications decreased from 3.8 to 2.8%. DBS was performed in medium- or high-volume centers in 70% of cases in 2000 and in 50% in 2007. In all groups, a majority of cases (range 65-71%) underwent DBS at hospitals in the western and southern USA.
  
  
  CONCLUSIONS
  Patients who underwent DBS in the 2007 sample were older and had more comorbidities than those in the 2000 sample; in-hospital complications remained low. Understanding trends in DBS is helpful in assessing how the technology is adopted and what relationships should be further explored.
authors.affiliation: Division of Neurosurgery, Albany Medical College, Albany, NY 12208, USA. pilitsj @ mail.amc.edu
authors.forename: Julie G
authors.initials: JG
authors.lastname: Pilitsis
authors.forename: Anthony
authors.initials: A
authors.lastname: Burrows
authors.forename: Mary Linton
authors.initials: ML
authors.lastname: Peters
authors.forename: Julie
authors.initials: J
authors.lastname: Sargent
authors.forename: Sing Chau
authors.initials: SC
authors.lastname: Ng
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Tseng
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D046690:Deep Brain Stimulation / Q000009:adverse effects; D020329:Essential Tremor / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000453:epidemiology* / Q000628:therapy*; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States