Long-Term Mortality Following STN-DBS in Parkinson's Disease: A Survival Analysis
Background: Deep brain stimulation of the subthalamic nucleus (STN-DBS) is an established PD treatment that improves motor symptoms and quality of life, but long-term survival and mortality risk remain poorly characterized. This study evaluated long-term survival and mortality-associated factors after STN-DBS. Methods: A retrospective survival analysis of 214 PD patients who underwent STN-DBS used Kaplan-Meier methods to estimate survival probabilities and median survival, with log-rank tests comparing survival by gender and age at implantation. Cox proportional hazards (Cox-PH) models identified mortality-associated factors in both univariate and multivariate analyses, and were validated using accelerated failure time (AFT) models. Results: Mortality rose progressively, with 8.0%, 42.5%, and 56.0% of patients dying within 5, 10, and 15 years, respectively; median survival was approximately 134 months. Survival did not differ by gender (p = 0.63) but was significantly lower for patients aged 60 years or older at implantation (p < 0.0001). At least one post-implantation revision reduced mortality risk (HR = 0.296, p < 0.001), while implantation at age 60 years or older increased it (HR = 4.689, p < 0.001); both remained significant after adjustment and were confirmed by AFT models. Patient satisfaction was high, with 97% of 52 surveyed patients reporting satisfaction and 96% would recommend STN-DBS. Conclusion: STN-DBS is linked to long-term survival and high patient satisfaction in individuals with PD. Older age at implantation increased mortality risk, whereas revision surgery and mortality likely reflect confounding by indication rather than a direct causal effect. These findings support age-stratified patient selection and highlight the importance of continued long-term monitoring following STN-DBS.