title: Cost of Deep Brain Stimulation Infection Resulting in Explantation.
abstract: Deep brain stimulation (DBS) hardware infection is a serious complication, often resulting in multiple hardware salvage attempts, hospitalizations, and long-term antibiotic therapy.
  
  
  
  We aimed to quantify the costs of DBS hardware-related infections in patients undergoing eventual device explantation.
  
  
  
  Of 362 patients who underwent 530 electrode placements (1 January 2010 to 30 December 2014), 16 (4.4%) had at least 2 hardware salvage procedures. Most (n = 15 [93.8%]) required complete explantation due to recurrent infection. Financial data (itemized hospital and physician costs) were available for 13 patients and these were analyzed along with the demographic data.
  
  
  
  Each patient underwent 1-5 salvage procedures (mean 2.5 ± 1.4; median 2). The mean total cost for a patient undergoing the median number of revisions (n = 2), device explantation, and subsequent reimplantation after infection clearance was USD 75,505; just over half this cost (54.2% [USD 40,960]) was attributable to reimplantation, and nearly one-third (28.9% [USD 21,816]) was attributable to hardware salvage procedures. Operating-room costs were the highest cost category for hardware revision and explantation. Medical and surgical supplies accounted for the highest reimplantation cost.
  
  
  
  DBS infection incurs significant health care costs associated with hardware salvage attempts, explantation, and reimplantation. The highest cost categories are operating-room services and medical and surgical supplies.
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
authors.forename: Tsinsue
authors.initials: T
authors.lastname: Chen
authors.forename: Zaman
authors.initials: Z
authors.lastname: Mirzadeh
authors.forename: Margaret
authors.initials: M
authors.lastname: Lambert
authors.forename: Omar
authors.initials: O
authors.lastname: Gonzalez
authors.forename: Ana
authors.initials: A
authors.lastname: Moran
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Shetter
authors.forename: Francisco A
authors.initials: FA
authors.lastname: Ponce
mesh_terms: D000328:Adult; D000368:Aged; D046690:Deep Brain Stimulation / Q000009:adverse effects* / Q000191:economics*; D020878:Device Removal / Q000191:economics* / Q000639:trends; D004866:Equipment Contamination / Q000191:economics*; D005260:Female; D017721:Hospital Costs / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics / Q000601:surgery; D012086:Reoperation / Q000191:economics* / Q000639:trends; D055815:Young Adult
keywords: Adverse events; Complications; Cost; Deep brain stimulation; Explantation; Infection