1383. Differences in Deep Brain Stimulation Surgery Outcomes in Rural and Urban Patient Populations

Authors: Michael Fana; Gregory Everett; Thomas Fagan; Sulmaz Zahedi; John Clements; Megan Mazzella (Mount Pleasant, MI)

Introduction: Deep brain stimulation(DBS) isa minimally invasive operation with limitations regarding access, including cost and a limited number of hospitals equipped with the technology. Previous studies have identified differences between race, sex, socioeconomic status, hospitals, income, comorbidities, and insurance in patients undergoing DBS. Our goal is to determine the predictive ability of patient variables on DBS outcomes, including patient dischargelocation, length of hospital stay, and costs. Methods: Retrospective cohort study using discharge data from the 2012 National Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP). Statistical analyses are performed using independent t-tests, chi-square, and linear and logistic regression models. Results: Comparative analyses between urban and rural patients demonstrate more urban patients have higher incomes and possess private insurance. In addition, urban patients were less often discharged home and more often accrued higher average hospital costs. Regression models show urban patients are 70% less likely to be discharged home compared to rural patients (OR = 0.300, 95% CI = 0.187-0.481). Moreover, patients presenting with a major loss of function prior to surgery are 81% less likely to be discharged home (OR = 0.190, 95% CI = 0.107-0.337) compared to those with minor loss of function. Finally, patients with greater loss of function prior to surgery or those from urban locations are more likely to have increased hospital costs and longer hospital stays than their rural counterparts. Conclusion: In this cohort study, urban patients or patients presenting with major illnesses are found more likely to have higher costs and longer hospital stays and are less likely to be discharged home. Future research should investigate variables besides those analyzed here as our data accounts for 11%, 4%, and 22% of the variation seen in routine disposition, total charges, and length of hospital stay, respectively.