title: An international survey of deep brain stimulation procedural steps.
abstract: BACKGROUND
  Deep brain stimulation (DBS) surgery is standard of care for the treatment of certain movement disorders.
  
  
  OBJECTIVE
  We sought to characterize the spectrum of steps performed in DBS surgery, at centers around the world where this surgery is performed.
  
  
  METHODS
  We identified the main steps in DBS surgery workflow and grouped these 19 steps into 3 phases (preoperative, operative, and postoperative). A survey tool, informed by a pilot survey, was administered internationally by trained study personnel at high- and low-volume DBS centers. Procedural components, duration, and surgeon motivational factors were assessed. Cluster analysis was used to identify procedural and behavioral clusters.
  
  
  RESULTS
  One hundred eighty-five procedure workflow surveys (143 DBS centers) and 65 online surveys of surgeon motivational drivers were completed (45% response rate). Significant heterogeneity in technique, operative time, and surgeon motivational drivers was reported across centers.
  
  
  CONCLUSIONS
  We provide a description of the procedural steps involved in DBS surgery and the duration of these steps, based on an international survey. These data will enable individual surgeons and centers to examine their own experience relative to colleagues at other centers and in other countries. Such information could also be useful in comparing efficiencies and identifying workflow obstacles between different hospital environments.
authors.affiliation: Department of Neurosurgery, University of Minnesota Medical Center, Minneapolis, MN 55414, USA. aabosch@umn.edu
authors.forename: Aviva
authors.initials: A
authors.lastname: Abosch
authors.forename: Lars
authors.initials: L
authors.lastname: Timmermann
authors.forename: Sylvia
authors.initials: S
authors.lastname: Bartley
authors.forename: Hans Guido
authors.initials: HG
authors.lastname: Rietkerk
authors.forename: Donald
authors.initials: D
authors.lastname: Whiting
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Connolly
authors.forename: David
authors.initials: D
authors.lastname: Lanctin
authors.forename: Marwan I
authors.initials: MI
authors.lastname: Hariz
mesh_terms: D000352:Africa, Northern; D001315:Australia; D046690:Deep Brain Stimulation / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D020821:Dystonic Disorders / Q000628:therapy; D020329:Essential Tremor / Q000628:therapy; D005060:Europe; D019538:Health Care Surveys; D006801:Humans; D007564:Japan; D009042:Motivation; D009493:Neurosurgery / Q000706:statistics & numerical data; D010300:Parkinson Disease / Q000628:therapy; D010820:Physicians / Q000523:psychology; D010865:Pilot Projects; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D013019:South Africa; D011795:Surveys and Questionnaires; D014481:United States