The Rate of Infectious Complications After Intrathecal Drug Delivery System Implant for Cancer-Related Pain Is Low Despite Frequent Concurrent Anticancer Treatment or Leukopenia

Abstract

BACKGROUND: The efficacy of intrathecal drug delivery (IDD) for cancer-related pain is well established. Cancer therapies are often associated with immunosuppression and increased risk of infection, and the rate of infection after intrathecal drug delivery system (IDDS) implant in cancer patients has been reported as 2.4%–6.3%. Our objective is to report on the rate of surgical site infections (SSI) in patients implanted with IDDS for cancer-related pain and to provide a data-driven discussion on the relationship between antineoplastic treatment, leukopenia, and other clinical or demographic characteristics and SSI. METHODS: Following local institutional review board approval, we conducted a retrospective chart review of IDDS implants from May 2014 through December 2018. Data collected included demographic data, health status, prophylactic antibiotic administration, surgery duration, presence of leukopenia (white blood cell [WBC] count of <4.0 K/µL) or moderate neutropenia (absolute neutrophil count [ANC] of <1000/μL) within the 30 days before IDDS implant, and details of antineoplastic treatment or systemic corticosteroid use in the perioperative period. This information was assessed in relation to SSI incidence up to 6 months following implant. RESULTS: Two hundred seventeen IDDS implants were identified. A majority of patients (79.3%) received ≥1 form of antineoplastic therapy within 30 days before or after implant, and 42.4% received multiple forms of antineoplastic therapy. Therapies included chemotherapy in 46.5%, immunotherapy in 28.6%, systemic steroids in 32.3%, and radiation therapy in 28.1%. One-quarter of patients (25.8%) were leukopenic within 30 days before implant, with 3.2% having moderate neutropenia. There were 2 infectious complications representing an infection rate of 0.9% (95% CI, 0.1%–3.3%), with limited shared characteristics between those experiencing SSI. CONCLUSIONS: SSI risk after IDDS placement for cancer pain is low, despite frequent concurrent antineoplastic therapy and leukopenia in the perioperative period. Concomitant cancer therapies should not be a barrier to the implementation of IDD for cancer pain.

The Effect of Measured Radiotherapy Dose on Intrathecal Drug Delivery System Function

“…This included cases where the pump was located within the radiation field and subjected to relatively high RT doses, in some instances more than the manufacturer's suggested maximum limit (7). The absence of infectious complications is notable as IDDS surgical site infections for cancer patients has been reported as 2.4-6.3% (10-12) at outside institutions and 0.9% in our own practice (13). Cancer types and locations were well represented, and RT spanned wide dose and intensity ranges.…”

The American Society of Pain and Neuroscience (ASPN) Best Practices and Guidelines for the Interventional Management of Cancer-Associated Pain

“… 102 , 116 , 122 , 124 , 125 A recent retrospective review in a large cancer center showed an infection incidence of 0.9% despite frequent concurrent cancer treatment and leukopenia. 127 In other studies, the incidence of infection in the cancer patient population was 2.7–3.2%. 128 , 129…”

Intrathecal Drug Delivery Systems Survey: Trends in Utilization in Pain Practice

“…Studies have shown contrary to this belief, the rates of surgical site infection for pain implants are not greater in cancer patients compared to patients without cancer. 19 , 22 However, a study by Hoelzer et al evaluating spinal cord stimulator implants did have a statistically significant decrease in incidence of surgical site infection with use of post-operative antibiotics for 7 days in non-cancer patients. 23 This practice may reflect provider preference based on these findings.…”