title: Postoperative delirium in Parkinson's disease patients following deep brain stimulation surgery.
abstract: Deep brain stimulation (DBS) surgery is an effective treatment for patients with advanced Parkinson's disease. Delirium in hospitalized Parkinson's disease patients is common and often leads to prolonged hospital stays. This study reports on the incidence and etiology of postoperative delirium following DBS surgery. Patients (n=59) with advanced Parkinson's disease underwent bilateral (n=56) or unilateral (n=3) DBS electrode implant surgery, followed 1 week later with surgical placement of DBS generators. The development of delirium during either hospital stay was evaluated retrospectively from the hospital chart. Potential causes of delirium were evaluated, including history of delirium, opiate equivalents, medication administration delays and missed doses during hospitalization, and Parkinson's disease duration. Delirium following implantation of DBS electrodes was common (22% of patients). It was less commonly associated with generator placement (10%). A history of delirium, age, and disease duration were positive predictors of delirium. Opiate equivalent doses were negatively correlated with delirium. Missed Parkinson's medication doses (53% of patients) and delayed administration (81% of patients) were common, and had a slight relation with delirium. Delirium was not related to complexity of medication regimen or use of dementia medications. Despite the presence of delirium most patients still only required a single night in the hospital post-surgery (67%). Prolonged hospital stay was due not only to delirium but also severe off states and other medical issues. Recognition and expectant management of delirium is best accomplished in a multidisciplinary setting, including the patient's family and nursing, pharmacy and neurological surgery staff.
authors: Inland Neurosurgery and Spine Associates, 105 W. 8th Avenue, Suite 200, Spokane, WA 99204, USA. Electronic address: jcarlson@neuroandspine.com.
authors: Jonathan D
authors: JD
authors: Carlson
authors: Department of Pharmacotherapy, College of Pharmacy, Washington State University, Spokane, WA, USA.
authors: Joshua J
authors: JJ
authors: Neumiller
authors: Department of Pharmacotherapy, College of Pharmacy, Washington State University, Spokane, WA, USA.
authors: Lindy D W
authors: LD
authors: Swain
authors: Northwest Neurological, Spokane, WA, USA.
authors: Jamie
authors: J
authors: Mark
authors: Inland Neurosurgery and Spine Associates, 105 W. 8th Avenue, Suite 200, Spokane, WA 99204, USA.
authors: Pam
authors: P
authors: McLeod
authors: Inland Neurosurgery and Spine Associates, 105 W. 8th Avenue, Suite 200, Spokane, WA 99204, USA.
authors: Jeff
authors: J
authors: Hirschauer
mesh_terms: D000368:Aged; D046690:Deep Brain Stimulation / Q000009:adverse effects*; D003693:Delirium / Q000209:etiology*; D004567:Electrodes, Implanted / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000628:therapy*; D012189:Retrospective Studies
keywords: Deep brain stimulation; Encephalopathy; Hospital stay; Medication errors; Parkinson’s disease