Impact of Wait times on Spinal Cord Stimulation Therapy Outcomes

Kumar, Krishna; Rizvi, Syed; Nguyen, Rita; Abbas, Mariam; Bishop, Sharon; Murthy, Vignesh

doi:10.1111/papr.12126

Cited by 44 publications

(50 citation statements)

References 29 publications

(81 reference statements)

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“…If the average wait time for SCS implantation is roughly five‐years, as reported from their single‐institution study, this certainly decreases long‐term success rates. Interestingly, they also noted that non‐implanting neurosurgeons referred to an implant physician around 1.7 times earlier than orthopedic surgeons and anesthesiologists , highlighting provider practice variability. Our results do not delineate provider types (orthopedic surgery, neurosurgery, pain management, and PM&R) within volume groups or procedure setting (acute care centers, private hospitals, or large academic centers); however, differences undoubtedly exist across different providers based on training, standard practice, and institutional variability.…”

Section: Discussionmentioning

confidence: 99%

Explantation Rates and Healthcare Resource Utilization in Spinal Cord Stimulation

Han

Murphy

Hussaini

et al. 2017

Neuromodulation: Technology at the Neural Interface

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OBJECTIVES Certain patients ultimately undergo explantation of their spinal cord stimulation (SCS) devices. Understanding the predictors and rates of SCS explantation has important implications for healthcare resource utilization (HCRU) and pain management. The present study identifies explant predictors and discerns differences in HCRU for at-risk populations. METHODS We designed a large, retrospective analysis using the Truven MarketScan Database. We included all adult patients who underwent a SCS trial from 2007 to 2012. Patients were grouped into cohorts that remained explant-free or underwent explantation over a 3-year period, and multivariate models evaluated differences in healthcare resource utilization. RESULTS A total of 8,727 unique instances of trial implants between 2007 and 2012 were identified. Overall, 805 (9.2%) patients underwent device explantation. One year prior to SCS implantation, the explant cohort had significantly higher median baseline costs ($42,140.3 explant vs. $27,821.7 in non-explant groups; p<0.0001), total number of pain encounters (180 vs. 103 p<0.0001), and associated costs ($15,446.9 vs. $9,227.9; p<0.0001). The explant cohort demonstrated increased use of procedures (19.0 vs. 9.0; p<0.0001) compared to non-explanted patients. For each month after initial SCS implantation, explanted patients had a slower decrease in total costs (4% vs. 6% in non-explant; p<0.01). At the month of explant, explant patients were expected to have incurred 2.65 times the total cost compared to the non-explant cohort (CR 2.65, 95% CI [1.83, 3.84]; p<0.001). Medium volume providers had lower rates of explantation at 1-year and 3-years compared to low volume providers (p=0.042). Increased age and Charlson index were independent predictors of explantation during the same periods. CONCLUSIONS In this nationwide analysis, we identified that SCS device explantation is correlated with patients who have higher baseline costs, higher total cost post-SCS implantation, and increased use of procedures to control pain. The higher rates of explantation at 3-years post-implant among low volume providers suggest that variations in provider experience and approach also contributes to differences in explantation rates.

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Section: Discussionmentioning

confidence: 99%

Explantation Rates and Healthcare Resource Utilization in Spinal Cord Stimulation

Han

Murphy

Hussaini

et al. 2017

Neuromodulation: Technology at the Neural Interface

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“…Это, в свою очередь, приводит к большой длительности периода между появлением болевого синдрома и имплантацией сис-темы спинальной нейростимуляции. Например, для па-циентов K. Kumar и соавторов [76] в Канаде это время составляло в среднем более 5 лет. При этом доля па-циентов, у которых SCS имела достоверный позитив-ный эффект, обратно пропорциональна этому сроку и составляла более 80% у пациентов со сроком до имп-лантации SCS менее 2 лет, 40-50% при сроке 5-8 лет и около 10% при сроке более 10 лет [76].…”

Section: Reviewsunclassified

“…Например, для па-циентов K. Kumar и соавторов [76] в Канаде это время составляло в среднем более 5 лет. При этом доля па-циентов, у которых SCS имела достоверный позитив-ный эффект, обратно пропорциональна этому сроку и составляла более 80% у пациентов со сроком до имп-лантации SCS менее 2 лет, 40-50% при сроке 5-8 лет и около 10% при сроке более 10 лет [76]. Кроме того, SCS имеет высокую эффективность только у части па-циентов, а рандомизация приводит к формированию смешанных в этом отношении групп.…”

Section: Reviewsunclassified

Spinal cord stimulation in treatment of patients with critical lower limb ischemia

Ashurkov¹,

Levin²,

Murtazin³

et al. 2017

PKiK

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Critical limb ischemia (CLI) is a state of substantial reduction of blood flow in the extremities, mostly due to severe obstruction of the arteries. In lower limbs, it produces severe pain after even a short distance walk (intermittent claudication) and/or skin ulcers or sores. Surgical revascularization is a “golden standard” in CLI therapy, but it is contraindicated or not accessible for a large proportion of patients, while the medical prognosis is poor for conservative therapy. This situation stimulated the development of alternative approaches, including spinal cord stimulation (SCS) and various methods of “indirect” revascularization. In this paper, the authors give a short description of the latest approaches and a detailed review of the SCS method, while paying special attention to the studies that demonstrate not only a palliative effect of SCS (pain reduction), but also clinically significant changes in the indicators of lower limb muscles blood supply. CLI is characterized with a "vicious circle": pain causes reduced mobility and changes in the preferred limb position, which in turn lead to edema triggering an increase of ischemia and further elevation of pain. The clinical effects of SCS in CLI patients are related both with pain relief leading to a break of this vicious circle, and with the direct vasodilatory effects of the stimulation itself. There are several possible biological mechanisms of these actions, but most probably the therapeutic actions of SCS arise from their combination. Examination of different opinions about the appropriateness of spinal cord stimulation in patients with CLI, including those related to the economic efficiency of the method, leads to the conclusion that the evidence on these issues is currently insufficient. The reviewed data demonstrate the need for further development of the CLI treatment methods and high urgency of this problem.Received 6 April 2017. Accepted 23 April 2017.Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest.

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“…Kumar et al observed an inverse correlation between the long-term success rate and the time interval between the onset of the chronic pain syndrome and SCS implantation. They noted that the success rate in patients who received their SCS system within the first 2 years of their pain syndrome was 85%, whereas the success rate was 9% in patients with a more than 15-year history of chronic pain 126,127. As a consequence, an SCS trial should be performed within the first 2 years after onset of pain.…”

Section: Long-term Outcomes and Place In Therapymentioning

confidence: 99%

Spinal cord stimulation for neuropathic pain: current perspectives

Wolter¹

2014

JPR

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Neuropathic pain constitutes a significant portion of chronic pain. Patients with neuropathic pain are usually more heavily burdened than patients with nociceptive pain. They suffer more often from insomnia, anxiety, and depression. Moreover, analgesic medication often has an insufficient effect on neuropathic pain. Spinal cord stimulation constitutes a therapy alternative that, to date, remains underused. In the last 10 to 15 years, it has undergone constant technical advancement. This review gives an overview of the present practice of spinal cord stimulation for chronic neuropathic pain and current developments such as high-frequency stimulation and peripheral nerve field stimulation.

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Impact of Wait times on Spinal Cord Stimulation Therapy Outcomes

Abstract: To improve SCS success rates, physicians involved in the treatment for chronic pain should refer these cases early to an implant physician once failure of medical management becomes apparent.

Cited by 44 publications

References 29 publications

Explantation Rates and Healthcare Resource Utilization in Spinal Cord Stimulation

Explantation Rates and Healthcare Resource Utilization in Spinal Cord Stimulation

Spinal cord stimulation in treatment of patients with critical lower limb ischemia

Spinal cord stimulation for neuropathic pain: current perspectives

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