title: Impact of an Interdisciplinary Deep Brain Stimulation Screening Model on Post-Surgical Complications in Essential Tremor Patients.
abstract: OBJECTIVE
  To investigate the relationship of our interdisciplinary screening process on post-operative unintended hospitalizations and quality of life.
  
  
  BACKGROUND
  There are currently no standardized criteria for selection of appropriate Deep Brain Stimulation candidates and little hard data exists to support the use of any singular method.
  
  
  METHODS
  An Essential Tremor cohort was selected from our institutional Deep Brain Stimulation database. The interdisciplinary model utilized seven specialties who pre-operatively screened all potential Deep Brain Stimulation candidates. Concerns for surgery raised by each specialty were documented and classified as none, minor, or major. Charts were reviewed to identify unintended hospitalizations and quality of life measurements at 1 year post-surgery.
  
  
  RESULTS
  Eighty-six percent (44/51) of the potential screened candidates were approved for Deep Brain Stimulation. Eight (18%) patients had an unintended hospitalization during the follow-up period. Patients with minor or major concerns raised by any specialty service had significantly more unintended hospitalizations when compared to patients without concerns (75% vs. 25%, p < 0.005). The rate of hospitalization revealed a direct relationship to the "level of concern"; ranging from 100% if major concerns, 42% if minor concerns, and 7% if no concerns raised, p = 0.001. Quality of life scores significantly worsened in patients with unintended hospitalizations at 6 (p = 0.046) and 12 months (p = 0.027) when compared to baseline scores. No significant differences in tremor scores between unintended and non-unintended hospitalizations were observed.
  
  
  CONCLUSIONS
  The number and level of concerns raised during interdisciplinary Deep Brain Stimulation screenings were significantly related to unintended hospitalizations and to a reduced quality of life. The interdisciplinary evaluation may help to stratify risk for these complications. However, data should be interpreted with caution due to the limitations of our study. Further prospective comparative and larger studies are required to confirm our results.
authors.affiliation: Department of Neurology, University of Florida College of Medicine, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America.
authors.forename: Masa-aki
authors.initials: MA
authors.lastname: Higuchi
authors.affiliation: Department of Neurology, University of Florida College of Medicine, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America.
authors.forename: Dan D
authors.initials: DD
authors.lastname: Topiol
authors.affiliation: Department of Neurology, University of Florida College of Medicine, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America.
authors.forename: Bilal
authors.initials: B
authors.lastname: Ahmed
authors.affiliation: Department of Neurology, University of Florida College of Medicine, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America.
authors.forename: Hokuto
authors.initials: H
authors.lastname: Morita
authors.affiliation: Department of Neurology, University of Florida College of Medicine, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America.
authors.forename: Samuel
authors.initials: S
authors.lastname: Carbunaru
authors.affiliation: Department of Neurology, University of Florida College of Medicine, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Hess
authors.affiliation: Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida, United States of America.
authors.forename: Dawn
authors.initials: D
authors.lastname: Bowers
authors.affiliation: Department of Psychiatry, University of Florida College of Medicine, Gainesville, Florida, United States of America.
authors.forename: Herbert E
authors.initials: HE
authors.lastname: Ward
authors.affiliation: Rehabilitation Services, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America.
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Warren
authors.affiliation: Rehabilitation Services, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America.
authors.forename: Meredith M
authors.initials: MM
authors.lastname: DeFranco
authors.affiliation: Department of Speech, Language, and Hearing Sciences, University of Florida College of Public Health and Health Professions, Gainesville, Florida, United States of America.
authors.forename: Michelle S
authors.initials: MS
authors.lastname: Troche
authors.affiliation: Rehabilitation Services, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America.
authors.forename: Shankar J
authors.initials: SJ
authors.lastname: Kulkarni
authors.affiliation: Department of Neurology, University of Florida College of Medicine, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America.
authors.forename: Erin
authors.initials: E
authors.lastname: Hastings
authors.affiliation: Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida, United States of America.
authors.forename: Kelly D
authors.initials: KD
authors.lastname: Foote
authors.affiliation: Department of Neurology, University of Florida College of Medicine, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America.|Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida, United States of America.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Okun
authors.affiliation: Department of Neurology, University of Florida College of Medicine, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America.
authors.forename: Daniel
authors.initials: D
authors.lastname: Martinez-Ramirez
mesh_terms: D000368:Aged; D015331:Cohort Studies; D046690:Deep Brain Stimulation / Q000009:adverse effects*; D020329:Essential Tremor / Q000628:therapy*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome