Anesthesia Modality Selection for Deep Brain Stimulation: A Nationwide Registry-based Study

Introduction: This study aims to analyze the characteristics of a nationwide cohort of patients undergoing asleep or awake Deep Brain Stimulation (DBS) for Parkinson’s disease, epilepsy, and essential tremor. Additionally, it seeks to identify predictors of adverse outcomes for both asleep and awake DBS, with the goal of supporting a tailored approach to anesthesia selection in DBS procedures.

Methods: The NSQIP was queried for all patients undergoing DBS between 2011 and 2020. The primary endpoint was short-term adverse outcome. Descriptive statistics were used to contrast awake and asleep cases. Propensity score matching was used to calibrate the groups and allow adjusted comparison. Multivariable logistic regression was performed to identify predictors of adverse outcomes.

Results: In total, 2,553 patients undergoing asleep (81%) and awake DBS procedures (19%) were identified. The median age among included was 63.0 (IQR: 48.0–71.0), with most being males (61%). After 2:1 propensity score matching there were no difference in any of the outcomes including, 30-day mortality, reoperation, readmission, and complication risks (p≥0.05). On multivariable regression, male sex (OR: 0.49; 95%CI: 0.35-0.69; p< 0.001), were independently associated with lower odds of adverse outcomes in patients undergoing asleep DBS. Whereas comorbidities such as diabetes (OR: 2.27; p< 0.001), or hypertension (OR: 2.94; p< 0.001), as well as patients with epilepsy as an indication for DBS treatment in comparison with patients with Parkinson’s disease (OR: 2.11; p=0.008) were independently associated with higher odds of adverse outcomes in patients undergoing asleep DBS. On the other hand, only elevated WBC was independently associated with an increased odd of adverse outcomes (OR: 5.57; p=0.006) in patients undergoing awake DBS.

Conclusion : In conclusion, higher odds of adverse outcomes with asleep DBS were observed in females, patients with epilepsy, diabetes, or hypertension, suggesting they may be less suited for this procedure. Conversely, patients with elevated WBC levels had higher odds of adverse outcomes in the awake DBS group, indicating that they may be less suited for the awake procedure.