Spinal Cord Stimulator Implant Infection Rates and Risk Factors: A Multicenter Retrospective Study

Hoelzer, Bryan C.; Bendel, Mark A.; Deer, Timothy R.; Eldrige, Jason S.; Walega, David R.; Wang, Zhen; Costandi, Shrif; Azer, Gerges; Qu, Wenchun; Falowski, Steven; Neuman, Stephanie A.; Moeschler, Susan M.; Wassef, Catherine; Kim, Christopher; Niazi, Tariq Khan; Saifullah, Taher; Yee, Brian A.; Kim, Chong; Oryhan, Christine; Rosenow, Joshua M.; Warren, Daniel T.; Lerman, Imanuel; Mora, Ruben; Hayek, Salim M.; Hanes, Michael; Simopoulos, Thomas; Sharma, Sanjiv; Gilligan, Christopher; Grace, Warren; Ade, Timothy; Mekhail, Nagy; Hunter, John P.; Choi, Daniel; Choi, Deborah Y.

doi:10.1111/ner.12609

Cited by 102 publications

(78 citation statements)

References 37 publications

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“…). This infection rate is in line with previous published data, while the time to occurrence of infection is similar to the reported rate by Hayek et al which demonstrate a median time to infection of 1.99 months. In addition, our data demonstrated no statistically significant difference between the likelihood of infection for patients with initial implants and replacement implants.…”

Section: Discussionsupporting

confidence: 93%

“…As confirmed in both the logistic regression and survival analysis, the expected risk factors for developing an SSI such as obesity, diabetes, and smoking were not identified as risk factors with this dataset, although smoking was found to individually increase the risk in those undergoing replacement procedures. A recent large retrospective chart analysis demonstrated similar conclusions . Future prospective studies with large study populations are needed to further assess the impact of these individual risk factors on SSIs with implantable pain therapies.…”

Section: Discussionmentioning

confidence: 65%

“…Two systematic reviews have reported SCS SSI rates of 3.4–4.6% . The number of patients in the primary studies are limited, ranging from 24 to 2737 patients .…”

Section: Introductionmentioning

confidence: 99%

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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: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 65%

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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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“…This dataset show S. aureus infection to be even more common than in prior studies, particularly with IPG pocket site infections, which assists in decision making with regard to antibiotic prophylaxis and infection treatment prior to obtaining wound cultures. This supports current clinical practice of routinely providing coverage against this bacterium .…”

Section: Discussionsupporting

confidence: 77%

Spinal Cord Stimulator Related Infections: Findings From a Multicenter Retrospective Analysis of 2737 Implants

Bendel

O'Brien

Hoelzer

et al. 2017

Neuromodulation: Technology at the Neural Interface

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“…Kumar et al found that about 17–20% of the patients decide not to proceed with the implantation although the trial period induced complete paraesthesia coverage of the painful region [33]. If the trial stimulation period has the indisputable advantage of avoiding probable unsuccessful implantation, on the other hand it carries a non-negligible risk of infection, which is reported to be between 2.4% and 18.6%, with consequent need of hardware removal and antibiotic therapy [34,35]. This wide range of infection rate reported is explained taking into account different factors, such as the single-centre surgical volume and surgeon experience [36].…”

Section: Scs Indications and Patient Selectionmentioning

confidence: 99%

Spinal Cord Stimulation for Neuropathic Pain: Current Trends and Future Applications

Dones

Levi

2018

Brain Sciences

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The origin and the neural pathways involved in chronic neuropathic pain are still not extensively understood. For this reason, despite the wide variety of pain medications available on the market, neuropathic pain is challenging to treat. The present therapeutic alternative considered as the gold standard for many kinds of chronic neuropathic pain is epidural spinal cord stimulation (SCS). Despite its proved efficacy, the favourable cost-effectiveness when compared to the long-term use of poorly effective drugs and the expanding array of indications and technical improvements, SCS is still worldwide largely neglected by general practitioners, neurologists, neurosurgeons and pain therapists, often bringing to a large delay in considering as a therapeutic option for patients affected by neuropathic chronic pain. The present state of the art of SCS in the treatment of chronic neuropathic pain is here overviewed and speculations on whether to use a trial period or direct implant, to choose between percutaneous leads or paddle electrodes and on the pros and cons of the different patterns of stimulation presently available on the market (tonic stim, high-frequency stim and burst stim) are described.

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Spinal Cord Stimulator Implant Infection Rates and Risk Factors: A Multicenter Retrospective Study

Cited by 102 publications

References 37 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

Spinal Cord Stimulator Related Infections: Findings From a Multicenter Retrospective Analysis of 2737 Implants

Spinal Cord Stimulation for Neuropathic Pain: Current Trends and Future Applications

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