Drivers and Risk Factors of Unplanned 30-Day Readmission Following Spinal Cord Stimulator Implantation

Elsamadicy, Aladine A.; Sergesketter, Amanda R.; Ren, Xinru; Hussaini, S. M. Qasim; Laarakker, Avra S.; Rahimpour, Shervin; Ejikeme, Tiffany; Yang, Sheng; Pagadala, Promila; Parente, Beth; Xie, Jichun; Lad, Shivanand P.

doi:10.1111/ner.12689

Cited by 19 publications

(10 citation statements)

References 30 publications

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“…SSIs are associated with significant humanistic, economic, and clinical consequences. Recent publications have highlighted the consequences of SSIs for implantable pain therapies and the low levels of compliance with evidence‐based guidelines . An analysis of the United States Closed Claims Project data base on implantable pain therapies indicated that infection was the most common damaging event (i.e., 23% of all claims) for surgical device‐related claims .…”

Section: Introductionmentioning

confidence: 99%

Spinal Cord Stimulation Infection Rate and Risk Factors: Results From a United States Payer Database

Falowski

Provenzano²,

Xia

et al. 2019

Neuromodulation: Technology at the Neural Interface

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Objective: Surgical site infections can cause negative clinical and economic outcomes. A recent international survey on Spinal Cord Stimulation (SCS) infection control practices demonstrated low compliance with evidence-based guidelines. This study defines infection rate for SCS implants and identifies infection risk factors. Results: In the logistic regression (n = 6615), 12 m device-related infection rate was 3.11%. Infection risk factors included peripheral vascular disease (OR, 1.784; 95% CI: 1.011-3.149; p = 0.0457) and infection in 12 m before implant (OR, 1.518; 95% CI: 1.022-2.254; p = 0.0386). The odds of patients experiencing an infection decreased by 3.2% with each additional year of age (OR, 0.968; 95% CI: 0.952-0.984; p < 0.0001). Survival analysis (n = 13,214) identified prior infection (HR, 1.770; 95% CI: 1.342-2.336; p < 0.0001) as a risk factor. Infection was less likely in older patients (HR, 0.974; 95% CI: 0.962-0.986; p < 0.0001). Expected risk factors including obesity, diabetes, and smoking were not identified as risk factors in this analysis. There was no significant difference between infection rate for initial and replacement implants.Conclusions: The 3.11% SCS-related infection rate within 12 m of implant emphasizes the need for improved infection control practices. Research is needed to limit SCS infections in younger patients and those with infection history.

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Section: Introductionmentioning

confidence: 99%

Spinal Cord Stimulation Infection Rate and Risk Factors: Results From a United States Payer Database

Falowski

Provenzano²,

Xia

et al. 2019

Neuromodulation: Technology at the Neural Interface

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“…An analysis of the United States Closed Claim Project database showed that the most common complication for surgical device-related claims for implantable pain therapies was infection, accounting for 23% of all claims 15. According to a research analysis looking at insurance claims database, the infection rate for SCS was found to be 3.11% 16. Provenzano et al studied infection rates and annual expenditures related to infections following SCS implantation and implantable pulse generators (IPG) replacement.…”

Section: Resultsmentioning

confidence: 99%

Trends in spinal cord stimulation utilization: change, growth and implications for the future

Chow

Rosenquist

2023

Reg Anesth Pain Med

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Chronic pain impacts more than 100 million Americans and has a significant impact on the economy and quality of life. Spinal cord stimulation (SCS) has demonstrated efficacy in managing a growing number of chronic pain conditions. This in combination with an increasing number of physicians trained in SCS placement has produced significant changes in utilization, expense and sites of service related to SCS. In particular, there has been a large increase in SCS placement by non-surgeons, use of percutaneous leads and performance in ambulatory surgery centers instead of inpatient settings. There are also notable differences in SCS use related to age, race, insurance coverage and geography. There is a large potential market and use of these therapies is predicted to grow from $2.41 billion in 2020 to $4.12 billion US dollars globally by 2027. At the same time, there is increasing scrutiny around utilization of this therapy related to cost, complications, long-term efficacy and explant rates that has the potential to impact access to this therapy in the future. We must examine our indications, technique and management to optimize outcomes and utilization of SCS going forward.

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“…Although the number of patients with obesity having SCS implants have increased over the years the cost of hospitalization was not different when compared with non-obese individuals undergoing SCS implant 69. Other observational studies have observed obesity to be an independent predictor of 30-day readmission after SCS implantation,70 as well as higher risk of complications including mechanical complications and lead migration 71. A significant negative association of body mass index (BMI) with SCS effectiveness was observed in a study with 2% reduction of SCS success with each unit increase of BMI72; and a BMI >36.5 kg/m 2 was associated with less improvement in depression and catastrophizing in patients on SCS therapy 73…”

Section: Committee Statements and Recommendationsmentioning

confidence: 98%

Evidence-based consensus guidelines on patient selection and trial stimulation for spinal cord stimulation therapy for chronic non-cancer pain

Shanthanna

Eldabe

Provenzano³

et al. 2023

Reg Anesth Pain Med

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Spinal cord stimulation (SCS) has demonstrated effectiveness for neuropathic pain. Unfortunately, some patients report inadequate long-term pain relief. Patient selection is emphasized for this therapy; however, the prognostic capabilities and deployment strategies of existing selection techniques, including an SCS trial, have been questioned. After approval by the Board of Directors of the American Society of Regional Anesthesia and Pain Medicine, a steering committee was formed to develop evidence-based guidelines for patient selection and the role of an SCS trial. Representatives of professional organizations with clinical expertize were invited to participate as committee members. A comprehensive literature review was carried out by the steering committee, and the results organized into narrative reports, which were circulated to all the committee members. Individual statements and recommendations within each of seven sections were formulated by the steering committee and circulated to members for voting. We used a modified Delphi method wherein drafts were circulated to each member in a blinded fashion for voting. Comments were incorporated in the subsequent revisions, which were recirculated for voting to achieve consensus. Seven sections with a total of 39 recommendations were approved with 100% consensus from all the members. Sections included definitions and terminology of SCS trial; benefits of SCS trial; screening for psychosocial characteristics; patient perceptions on SCS therapy and the use of trial; other patient predictors of SCS therapy; conduct of SCS trials; and evaluation of SCS trials including minimum criteria for success. Recommendations included that SCS trial should be performed before a definitive SCS implant except in anginal pain (grade B). All patients must be screened with an objective validated instrument for psychosocial factors, and this must include depression (grade B). Despite some limitations, a trial helps patient selection and provides patients with an opportunity to experience the therapy. These recommendations are expected to guide practicing physicians and other stakeholders and should not be mistaken as practice standards. Physicians should continue to make their best judgment based on individual patient considerations and preferences.

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Drivers and Risk Factors of Unplanned 30-Day Readmission Following Spinal Cord Stimulator Implantation

Cited by 19 publications

References 30 publications

Spinal Cord Stimulation Infection Rate and Risk Factors: Results From a United States Payer Database

Spinal Cord Stimulation Infection Rate and Risk Factors: Results From a United States Payer Database

Trends in spinal cord stimulation utilization: change, growth and implications for the future

Evidence-based consensus guidelines on patient selection and trial stimulation for spinal cord stimulation therapy for chronic non-cancer pain

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