Post-Operative Infections and Wound Erosion After Deep Brain Stimulation: Development of a Predictive Model and Clinical Risk Score

Introduction: Deep brain stimulation (DBS) is a highly effective method in the treatment of a variety of neurological disorders. While patient risk characteristics and comorbidities towards complications have been well-studied, a more predictive, pre-operative, and individualized approach is lacking. We sought to develop a preoperative clinical risk store for device infection and wound dehiscence after DBS procedures informed by preoperative and intraoperative risk factors.

Methods: We performed a single-institution retrospective chart review of 1238 consecutive cases undergoing Stage 1 DBS procedures from 2010 to 2023, identifying patients with CPT and ICD9/10 codes. Logistic regressions were performed for predictors of infection and wound dehiscence with prespecified models: 1) a priori variables and 2) predictors selected by large effect sizes. A final model was created by backwards elimination of non-significant predictors and used to derive an integer based clinical risk score. Internal validation was conducted with bootstrapping and 10-fold cross validation.

Results: A total of 43 (3.5%) device infections or wound erosions occurred after DBS procedures. The most common location of device infectino was at the IPG (53%). Patients who had a history of infection (OR 2.28,p=0.033), history of leukopenia (OR 33.8,p=0.016), were smokers (OR 3.69,p=0.016), and younger than 45 years of age (OR 1.31,p=0.01 ) had increased odds of device infection. Patients who were younger than 45 (OR 6.79,p=0.021) were at increased odds of device erosion. The final model included age, history of infections, smoking status, history of hematologic disease, and peripheral vascular disease. The clinical risk score was moderately predictive (cross-validated area under the receiver operative characteristic curve (cvAUROC 0.72, 95%CI 0.62 – 0.82) and was moderately sensitive (0.83 95%CI 0.81-0.85) and specific (0.51, 95%CI 0.35-0.67), correctly classifying 82% of the cases.

Conclusion : We identified novel risk factors and created the first generalizable predictive risk score to identify patients at risk of infection or wound dehiscence after DBS implantation. This clinical score will potentially improve patient management and pre-operative surgical optimization and counseling for risk potential.