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Referrals for Movement Disorder Surgery: Under-Representation of Females and Reasons for Refusal

Published online by Cambridge University Press:  02 December 2014

M. Setiawan ,
S. Kraft ,
K. Doig ,
K. Hunka ,
A. Haffenden ,
M. Trew ,
S. Longman ,
R. Ranawaya ,
S. Furtado  and
R.G. Lee
...Show all authors
M. Setiawan
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Foothills Hospital - Calgary Health Region, Calgary, AB, Canada
S. Kraft
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Foothills Hospital - Calgary Health Region, Calgary, AB, Canada
K. Doig
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Foothills Hospital - Calgary Health Region, Calgary, AB, Canada
K. Hunka
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Foothills Hospital - Calgary Health Region, Calgary, AB, Canada
A. Haffenden
Affiliation:
Department of Psychology, University of Calgary, Foothills Hospital - Calgary Health Region, Calgary, AB, Canada
M. Trew
Affiliation:
Department of Psychiatry, University of Calgary, Foothills Hospital - Calgary Health Region, Calgary, AB, Canada
S. Longman
Affiliation:
Department of Psychology, University of Calgary, Foothills Hospital - Calgary Health Region, Calgary, AB, Canada
R. Ranawaya
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Foothills Hospital - Calgary Health Region, Calgary, AB, Canada
S. Furtado
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Foothills Hospital - Calgary Health Region, Calgary, AB, Canada
R.G. Lee
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Foothills Hospital - Calgary Health Region, Calgary, AB, Canada
O. Suchowersky
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Foothills Hospital - Calgary Health Region, Calgary, AB, Canada
Z.H.T. Kiss*
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Foothills Hospital - Calgary Health Region, Calgary, AB, Canada
*
Rm 182A, Heritage Medical Research Building, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1, Canada
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Abstract:

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Objective:

Referral of movement disorder patients for deep brain stimulation surgery was examined to determine whether referred patients were representative of gender proportions in our population, and reasons why patients do not proceed to surgery.

Methods:

Demographic information on referrals to the surgical program was retrospectively reviewed from our database and from a detailed chart review.

Results:

Although almost equal numbers of movement disorder patients are male and female, of the 91 patients referred for surgery, only 31% were female. Sixty-one percent of referred patients did not undergo surgery. Of these, the majority were denied for medical reasons, including cognitive decline (21%), psychiatric concerns (5%) and neurological reasons (42%).

Conclusions:

Almost one-third of patients referred for movement disorder surgery were denied for medical reasons. This underscores the importance of evaluation of all potential patients by a multidisiplinary team to fully assess suitablity for stereotactic surgery. Interestingly, women were under-represented in those referred. In order that all appropriate patients have the opportunity to consider surgery, education of both physicians and patients, and different strategies to approach females regarding surgery may allow more patients to benefit from this treatment.

Résumé

RÉSUMÉ Objectif:

L'orientation des patients atteints de troubles du mouvement vers la neurochirurgie pour stimulation cérébrale profonde a été examinée afin de déterminer si la proportion de ces patients par sexe était représentative de cette proportion dans notre population et pourquoi un certain nombre de ces patients ne subissent pas l'intervention.

Méthodes:

Il s'agit d'une analyse rétrospective de l'information démographique sur les patients orientés en chirurgie contenue dans notre base de données et obtenue également d'une revue détaillée de dossiers.

Résultats:

Bien qu'un nombre presque égal d'hommes et de femmes soient atteints de troubles du mouvement, seulement 31% des 91 patients orientés en chirurgie étaient des femmes. La chirurgie n'a pas été effectuée chez soixante et un pour cent d'entre eux, la plupart du temps pour des raisons médicales, soit un déclin cognitif chez 21%, des problèmes de nature psychiatrique chez 5% et de nature neurologique chez 42%.

Conclusions:

Un peu moins du tiers des patients orientés vers la chirurgie pour un trouble du mouvement n'ont pas subi cette chirurgie pour des raisons médicales. Cette constatation souligne l'importance d'une évaluation globale par une équipe multidisciplinaire de tous les patients candidats à la chirurgie stéréotaxique. Il est intéressant de noter que les femmes étaient sous-représentées parmi les patients orientés vers la chirurgie. Pour que tous les patients éligibles aient la possibilité d'y avoir accès, l'éducation des médecins et des patients et des stratégies différentes pour rejoindre les femmes pourraient permettre à un plus grand nombre de patients d'en bénéficier.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 33 , Issue 1 , February 2006 , pp. 53 - 57
Copyright
Copyright © The Canadian Journal of Neurological 2006

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