Journal article
Risk Factors and Survival Analysis of Spinal Cord Stimulator Explantation
Neuromodulation (Malden, Mass.), Vol.24(1), pp.61-67
01/2021
DOI: 10.1111/ner.13173
PMID: 32491256
Abstract
Objective
The treatment failure rate for spinal cord stimulators (SCS) remains unacceptably high, with reports of removal in up to 30% of patients. The purpose of this study is to perform survival and multivariate regression analyses of patients who have undergone SCS explantation in order to identify patient characteristics that may predict treatment failure.
Materials and Methods
We identified 253 patients who underwent SCS placement using current procedural terminology codes in a private health insurance data base spanning 2003–2016. Patient demographics, opioid use, surgical indications, as well as comorbidities were noted. At least 6 months of continuous claims data before and after implantation were required for inclusion. Patients who underwent explantation were defined as those who underwent removal without replacement within 90 days and had at least 90 days of continuous insurance eligibility following removal. Those who underwent removal for infectious reasons were identified with corresponding diagnosis codes.
Results
Of the 252 patients who met the inclusion criteria, 17 (6.7%) underwent SCS explantation. Median follow‐up time was 2.0 years. Of those who had their system explanted, six patients (2.8%) had their systems removed for infection and 11 (4.3%) for noninfectious reasons. Bivariate analysis revealed that younger age and tobacco use were associated with an increased likelihood of explantation. The Cox proportional hazards analysis demonstrated that younger age, tobacco use, and the presence of “other” mental health disorders were predictive of explantation.
Conclusions
In a cohort of SCS patients from multiple institutions, this study demonstrates that explantation for noninfectious reasons is more likely in younger patients, tobacco users, and those with certain psychiatric conditions. With an estimated 10% of patients opting to have their devices removed within 5 years of implantation, refining the ability of clinicians to predict who will see benefit from SCS treatment remains necessary.
Details
- Title: Subtitle
- Risk Factors and Survival Analysis of Spinal Cord Stimulator Explantation
- Creators
- Mark C Dougherty - University of Iowa Carver College of MedicineRoyce W Woodroffe - University of Iowa Carver College of MedicineSaul Wilson - University of Iowa Carver College of MedicineGeorge T Gillies - University of VirginiaMatthew A Howard - University of Iowa Carver College of MedicineRyan M Carnahan - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Neuromodulation (Malden, Mass.), Vol.24(1), pp.61-67
- DOI
- 10.1111/ner.13173
- PMID
- 32491256
- NLM abbreviation
- Neuromodulation
- ISSN
- 1094-7159
- eISSN
- 1525-1403
- Publisher
- John Wiley & Sons, Inc; Hoboken, USA
- Number of pages
- 7
- Grant note
- National Center for Injury Prevention and Control (R49 PA‐CE001167)
- Language
- English
- Date published
- 01/2021
- Academic Unit
- Neurology; Epidemiology; Iowa Neuroscience Institute; Nursing; Injury Prevention Research Center; Neurosurgery; Otolaryngology
- Record Identifier
- 9984070477202771
Metrics
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