title: Surgical Replacement of Implantable Pulse Generators in Deep Brain Stimulation: Adverse Events and Risk Factors in a Multicenter Cohort.
abstract: Deep brain stimulation (DBS) is a growing treatment modality, and most DBS systems require replacement of the implantable pulse generator (IPG) every few years. The literature regarding the potential impact of adverse events of IPG replacement on the longevity of DBS treatments is rather scarce.
  
  
  
  To investigate the incidence of adverse events, including postoperative infections, associated with IPG replacements in a multicenter cohort.
  
  
  
  The medical records of 808 patients from one Australian and five Swedish DBS centers with a total of 1,293 IPG replacements were audited. A logistic regression model was used to ascertain the influence of possible predictors on the incidence of adverse events.
  
  
  
  The overall incidence of major infections was 2.3% per procedure, 3.7% per patient and 1.7% per replaced IPG. For 28 of 30 patients this resulted in partial or complete DBS system removal. There was an increased risk of infection for males (OR 3.6, p = 0.026), and the risk of infection increased with the number of prior IPG replacements (OR 1.6, p < 0.005).
  
  
  
  The risk of postoperative infection with DBS IPG replacement increases with the number of previous procedures. There is a need to reduce the frequency of IPG replacements.
authors.affiliation: Neurosurgery, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Fytagoridis
authors.forename: Tomas
authors.initials: T
authors.lastname: Heard
authors.forename: Jennifer
authors.initials: J
authors.lastname: Samuelsson
authors.forename: Peter
authors.initials: P
authors.lastname: Zsigmond
authors.forename: Elena
authors.initials: E
authors.lastname: Jiltsova
authors.forename: Simon
authors.initials: S
authors.lastname: Skyrman
authors.forename: Thomas
authors.initials: T
authors.lastname: Skoglund
authors.forename: Terry
authors.initials: T
authors.lastname: Coyne
authors.forename: Peter
authors.initials: P
authors.lastname: Silburn
authors.forename: Patric
authors.initials: P
authors.lastname: Blomstedt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D046690:Deep Brain Stimulation / Q000009:adverse effects* / Q000295:instrumentation*; D020878:Device Removal / Q000009:adverse effects*; D004567:Electrodes, Implanted / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000601:surgery*; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology