Hardware Infections in Deep Brain Stimulation Surgery for Parkinson Disease Over 16 Years: A Retrospective Review

Cham CY and Muthusamy KA

Division of Neurosurgery, University of Malaya, Malaysia

^*Correspondance to: Chun Yoong Cham 

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Abstract:

Introduction: The burden of Parkinson’s Disease (PD) is expected to increase as Malaysia’s population continues to age. Deep Brain Stimulation Surgery (DBS) is a recognized surgical therapy with excellent outcomes but one of the commonest complications of DBS include Superficial Surgical Site Infection (SSI). We performed a retrospective study to determine the incidence of SSI and the factors associated with it over 16 years at a quaternary university hospital in Kuala Lumpur, Malaysia.
Methods: This is a retrospective database study with ethical clearance from the university committee. All patients who underwent DBS for PD between January 1st, 2004 to December 31st, 2020 were included. The incidence of SSI was defined as per 2012 CDC guidelines and hardware infections were classified as early (<90 days) and late (90 or more days). Patient demographics and variables of interest were tabulated and analyzed.
Results: 153 cases of DBS were performed in 128 patients consisting of 289 lead implantation and 161 Implantable Pulse Generators (IPG) devices. Four patient who had DBS for non-PD were excluded. There were 7 cases of SSI with an incidence of 4.7% per case. Of these 7 cases, 4 were early SSI and 2 were late SSI. One patient’s data from 2004 was missing. Patients with prior Traumatic Brain Injury (TBI) and Stevens-Johnson Syndrome (SJS) were found to have significant association with SSI (p=0.047). Five patients (71.4%) were initially treated surgically with debridement, externalization and complete hardware removal however all 7 patients eventually had complete hardware removal. There was zero mortality. Average duration of hospital stay in the SSI group was almost 8-times longer than an uncomplicated case. The commonest location of SSI was on the scalp (42.8%) and the most frequent organism cultured was MSSA.
Conclusion: Rates of SSI have been reducing in recent years likely due to improved sterility practices, better surgical techniques, sturdier hardware. Hardware salvage is not an effective option in our region and there should be lesser resistance to hardware removal for better surgical and patient outcomes.

Keywords:

DBS; Parkinson’s disease; SSI; Removal; Salvage

Cite the Article:

Cham CY, Muthusamy KA. Hardware Infections in Deep Brain Stimulation Surgery for Parkinson Disease Over 16 Years: A Retrospective Review. World J Surg Surgical Res. 2023; 6: 1456..