TY - JOUR
T1 - Incidence, Reasons, and Predictors of Explantation of Sacral Neuromodulator
T2 - a Single-Institution Experience
AU - Chong, Woojin
AU - Hua, Peiying
AU - Gaigbe-Togbe, Bertille
AU - Overbey, Jessica
N1 - Publisher Copyright:
© 2020, Springer Nature Switzerland AG.
PY - 2020/10/1
Y1 - 2020/10/1
N2 - Sacral neuromodulator (SNM) explantation is associated with higher cost and significant morbidity. The objectives were to investigate the incidence, reasons, and predictors of SNM explantation at our institution and evaluate whether combined versus staged procedures are associated with increased SNM explantation rates. A retrospective chart review of subjects with SNM implantation between Jan 2012 and Dec 2017 was performed. Explantation-free survival was estimated using the Kaplan-Meier method, and associations of demographic and clinical characteristics with time to explantation were assessed using Cox regression. One hundred three subjects were included in the final analysis. Of which, 39 underwent staged procedures and 64 received combined procedures. General surgeons implanted most SNMs (102/103) primarily for fecal incontinence (90.3%). The median follow-up time was 9.5 months (IQR 4.3, 30.0). Twelve subjects (11.7%) underwent explantation with an incidence rate of 0.006 per person-month (95% CI 0.003, 0.011). The mean time to explantation was 25 months (SD ± 16.9 months). The most common reason for explantation was loss of efficacy (58.3%). In univariable analyses, only age (HR 0.97(95%CI 0.93–1.00); p = .04) was significantly associated with explantation. Subjects that underwent staged procedures were more likely to undergo explantation at any given time compared with subjects that underwent combined procedures, however, it was not statistically significant (HR 2.91(95%CI 0.87–9.71); p = .08). Over a 6-year period, the incidence of SNM explantation was 0.006 per person-month at our institution. The most common reason for SNM explantation was loss of efficacy. Older subjects were more likely to get explantation. Compared to subjects who had a staged procedure, those who had a combined procedure did not have a significantly different rate of explantation in our population. Further prospective studies are warranted.
AB - Sacral neuromodulator (SNM) explantation is associated with higher cost and significant morbidity. The objectives were to investigate the incidence, reasons, and predictors of SNM explantation at our institution and evaluate whether combined versus staged procedures are associated with increased SNM explantation rates. A retrospective chart review of subjects with SNM implantation between Jan 2012 and Dec 2017 was performed. Explantation-free survival was estimated using the Kaplan-Meier method, and associations of demographic and clinical characteristics with time to explantation were assessed using Cox regression. One hundred three subjects were included in the final analysis. Of which, 39 underwent staged procedures and 64 received combined procedures. General surgeons implanted most SNMs (102/103) primarily for fecal incontinence (90.3%). The median follow-up time was 9.5 months (IQR 4.3, 30.0). Twelve subjects (11.7%) underwent explantation with an incidence rate of 0.006 per person-month (95% CI 0.003, 0.011). The mean time to explantation was 25 months (SD ± 16.9 months). The most common reason for explantation was loss of efficacy (58.3%). In univariable analyses, only age (HR 0.97(95%CI 0.93–1.00); p = .04) was significantly associated with explantation. Subjects that underwent staged procedures were more likely to undergo explantation at any given time compared with subjects that underwent combined procedures, however, it was not statistically significant (HR 2.91(95%CI 0.87–9.71); p = .08). Over a 6-year period, the incidence of SNM explantation was 0.006 per person-month at our institution. The most common reason for SNM explantation was loss of efficacy. Older subjects were more likely to get explantation. Compared to subjects who had a staged procedure, those who had a combined procedure did not have a significantly different rate of explantation in our population. Further prospective studies are warranted.
KW - Fecal incontinence
KW - Neurostimulator explantation
KW - Sacral nerve stimulation
KW - Urinary incontinence
UR - https://www.scopus.com/pages/publications/105016002914
U2 - 10.1007/s42399-020-00483-x
DO - 10.1007/s42399-020-00483-x
M3 - Article
AN - SCOPUS:105016002914
SN - 2523-8973
VL - 2
SP - 1869
EP - 1875
JO - SN Comprehensive Clinical Medicine
JF - SN Comprehensive Clinical Medicine
IS - 10
ER -