Trends In Deep Brain Stimulation Surgery in The United States

INTRODUCTION: Deep brain stimulation (DBS) procedures vary by use of microelectrode recording (MER) and by unilateral or bilateral implantation. Our goal was to quantify national, regional, and state-level trends in total procedures, MER utilization, and unilateral vs bilateral electrode implantation. METHODS: The Centers for Medicare and Medicaid Services database was queried for patients undergoing DBS procedures from 2013-2023 yielding 27,846 total patients. Use of MER, unilateral vs bilateral DBS electrode implantation, and procedure location were extracted. Data was analyzed using Shapiro-Wilk test, Pearson's Correlation Coefficient, Spearman's Correlation Coefficient, ANOVA or Kruskal Wallis with post hoc testing, and Benjamini-Hochberg correction. RESULTS: From 2013-2023, total DBS electrode implantation procedures did not change significantly. MER+ DBS was more common than MER- DBS across all years, although MER- DBS increased over time (r=0.94) while MER+ DBS decreased over time (r=-0.75). Bilateral DBS increased (r=0.86) over time and in 2021 became more common than unilateral DBS, which decreased over time (r=-0.73). Unilateral and bilateral MER- DBS increased (r=0.84, 0.95), while unilateral MER+ DBS decreased (r=-0.97). All regions had an increase in MER- DBS (r=0.96, 0.81, 0.94, 0.84, respectively). The West performed the most MER- DBS, while the South performed the most MER+ DBS. The Midwest and West had an increase in percentage of bilateral DBS (r=0.95, 0.90, respectively). Regional changes favoring MER- DBS and bilateral electrode implantation were noticed in many states. All reported significant outcomes had p<0.05. CONCLUSION: Nationally, there is a trend towards performing bilateral and MER- DBS. Recently, there are more bilateral than unilateral procedures, but MER+ is still more common than MER-. Regional differences in DBS surgery also exist. These findings have implications for the experience of patients, neurosurgical trainees, and institutions across the USA.