Outcomes Associated With Infection of Chronic Pain Spinal Implantable Electronic Devices: Insights From a Nationwide Inpatient Sample Study

Authors

• Vasudha Goel, Department of Anesthesiology, University of Minnesota, Minneapolis, MN, USA.
• Varun Kumar, Department of Neurology, University of South Florida, Tampa, FL, USA.
• Shivani N. Agrawal, American University of Integrative Sciences, Cole Bay, Sint Maarten.
• Amol M. Patwardhan, Department of Anesthesiology, University of Arizona, Tucson, AZ, USA.
• Mohab Ibrahim, Department of Anesthesiology, University of Arizona, Tucson, AZ, USA.
• Daniel C. DeSimone, Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
• Eellan Sivanesan, Department of Anesthesiology, Johns Hopkins University, Baltimore, MD, USA.
• Ratan K. Banik, Department of Anesthesiology, University of Minnesota, Minneapolis, MN, USA.
• Hariharan Shankar, Department of Anesthesiology, Clement Zablocki VA Medical Center, Medical College of Wisconsin, Milwaukee, WI, USA.

Document Type

Article

Abstract

OBJECTIVES: Chronic pain spinal implantable electronic devices (CPSIEDs) include devices that provide spinal cord stimulation and intrathecal drug therapy. In this study, we sought to evaluate the trends of CPSIED infections, related complications, and outcomes following the treatment of infection. MATERIALS AND METHODS: The Nationwide Inpatient Sample database contains data from 48 states, and the District of Columbia was used to identify patients with a primary diagnosis of CPSIED infection during the years 2005-2014. Patients with intrathecal pumps for the treatment of spasticity were excluded to limit the study population to patients with chronic pain disorders. Treatments were categorized as: 1) without device removal, 2) pulse generator or pump only removal, 3) intrathecal pump system removal, and 4) spinal cord stimulation system removal. Complications associated with CPSIED infections were identified using administrative billing codes. RESULTS: During the study period 2005-2014, a total of 11,041 patients were admitted to the hospital with CPSIED infections. The majority of the patients were treated without surgical intervention (56%), and a smaller proportion underwent complete system explantation (22.7%). In-hospital mortality or permanent disability due to paralysis after CPSIED infection was around 1.83% and 2.77%, respectively. Infectious complications such as meningitis, abscess formation, and osteomyelitis occurred in 4.93%, 5.08%, and 1.5%, respectively. The median cost of hospitalization was around US $14,118.00, and the median length of stay was approximately six days (interquartile range = 4-13 days). CONCLUSIONS: The complications of CPSIED infection were higher among patients that did not undergo device removal.

Medical Subject Headings

Chronic Pain (epidemiology, therapy); Electronics; Humans; Infusion Pumps, Implantable; Inpatients; Muscle Spasticity; Spinal Cord Stimulation (adverse effects)

Publication Date

1-1-2021

Publication Title

Neuromodulation : journal of the International Neuromodulation Society

E-ISSN

1525-1403

Volume

24

Issue

1

First Page

126

Last Page

134

PubMed ID

32929856

Digital Object Identifier (DOI)

10.1111/ner.13263

Recommended Citation

Goel, Vasudha; Kumar, Varun; Agrawal, Shivani N.; Patwardhan, Amol M.; Ibrahim, Mohab; DeSimone, Daniel C.; Sivanesan, Eellan; Banik, Ratan K.; and Shankar, Hariharan, "Outcomes Associated With Infection of Chronic Pain Spinal Implantable Electronic Devices: Insights From a Nationwide Inpatient Sample Study" (2021). Neurology. 2080.
https://scholar.barrowneuro.org/neurology/2080