Staged Versus Simultaneous Bilateral Deep Brain Stimulation: A Matched Comparison of Outcomes and Resource Utilization

BACKGROUND AND OBJECTIVES: Deep brain stimulation (DBS) is a widely used treatment for movement disorders. While bilateral implantation is common, whether to implant electrodes in separate (staged) procedures or in a single (simultaneous) session remains debated. METHODS: In this retrospective matched cohort study, 252 patients who underwent staged bilateral DBS were propensity matched to 252 who underwent simultaneous procedures (n = 504) based on age, sex, and diagnosis. Demographic, clinical, and operative data were extracted from the electronic medical record. RESULTS: Staged patients were older (71.7 ± 6.4 vs 65.6 ± 6.9 years, P < .0001) and had lower body mass index (27.4 ± 5.4 vs 29.1 ± 6.5 kg/m 2 , P = .003). Parkinson's disease predominated in staged cases (54%) and essential tremor in simultaneous (69%) ( P < .001); dystonia was rare and similarly distributed ( P = .261). DBS targets differed: subthalamic nucleus and globus pallidus internus were more common in staged cases and ventral intermediate nucleus in simultaneous ( P < .0001). Sex, race, American Society of Anesthesiologists status classification system scores, and major comorbidities were similar ( P > .05). Staged DBS was associated with greater anesthesia utilization, operating room time, and hospital days (all P < .0001). After adjustment for covariates, there were no significant differences in intraoperative complications, postoperative complications, postoperative delirium, 30-day readmissions, medication dose reduction at 1 year, or reoperation within 5 years (odds ratios 0.81-1.44, all P > .5). CONCLUSION: Staged and simultaneous bilateral DBS yield similar clinical outcomes; however, staged procedures require significantly greater resource utilization and subject patients to a more prolonged treatment course.