• Jonathan Dennis Carlson, Meghan Palmer, Aiden Hoefer, Emily Cox, Pam McLeod, Jamie Mark, and Jason Aldred.
• Inland Neurosurgery and Spine Associates, Spokane, Washington, USA. Electronic address: jonathan.carlson@providence.org.
• World Neurosurg. 2019 Aug 1; 128: e683-e687.

BackgroundThe decision to replace deep brain stimulation (DBS) generators in end-stage Parkinson disease (PD) is based on the patients' clinical status and the risks of this surgery. The infection rates of initial DBS implantation surgery and generator replacement surgery are well established. But the risks of DBS generator replacement for the severely disabled end-stage PD patient have not been described.MethodsA retrospective analysis of all DBS procedures (n = 446) for PD spanning 20 years in a single institution was performed. The focus was on generator replacement procedure performed in end-stage PD. Infections related to DBS surgery were evaluated.ResultsPerioperative infections (<90 days) after generator replacements occurred in 0.6% of 172 cases and 2.5% of 232 primary lead implantation. Delayed infections (>90 days) occurred in 2.7% of all cases. Generator replacement was performed in 11 end-stage PD patients. None of these patients developed perioperative or delayed infections, and none were readmitted for medical or surgical complications.ConclusionsDBS generator replacement surgery is low risk, even in patients who have end-stage PD.Copyright © 2019 Elsevier Inc. All rights reserved.

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