SPINAL CORD STIMULATION INFECTION RATE AND RISK FACTORS: RESULTS FROM A US PAYER DATABASE

• Published in: Value in health Vol. 20; no. 5; p. A8
• Main Authors: Falowski, SM, Provenzano, DA, Xia, Y, Doth, AH
• Format: Journal Article
• Language: English
• Published: Lawrenceville Elsevier Science Ltd 01.05.2017
• Subjects: Clinical outcomes; Comorbidity; Demography; Disease control; Geriatrics; Implants; Infections; Medicare; Older people; Risk factors; Spinal cord; Statistical analysis; Stimulation; Surgical site infections; Trade; Transplants & implants
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2017.05.005

OBJECTIVES: Surgical Site Infections can result in significant negative clinical and economic outcomes. The objectives of this study are to define the infection rate for SCS implants, to identify patient characteristics that increase the risk for SCS infection. METHODS: Data from the Truven MarketScamfi Commercial Claims and Medicare Supplemental databases were used to identify patients with a SCS neurostimulator generator implant during the calendar years 2009-2014. Patients were continuously enrolled for at least 12-months before generator implant. Kaplan-Meier curves were conducted to compare the SCS infection rates between the initial implant group and the replacement implant group. COX proportional hazard regression was performed to characterize the risk factors for SCS infection based on patient demographics, common comorbidities, and other clinical characteristics. RESULTS: A total of 13,214 patients were identified. The SCS infection rates were 3.15% in the initial group and 2.96% in the replacement group at the end of 1 year after SCS generator implants. The result of log-rank test showed the difference of infection rates between two groups was not statistically significant (pvalue= 0.7916). Risk factors for SCS infection included a comorbidity of lumbar disk disease (Hazard Ratio (HR), 1.302; 95% CI: 1.015-1.671; p-value=0.0381) as well as a history of prior all-cause infection (HR, 1.770; 95% CI: 1.342-2.336; p-value <0.0001). In addition, elderly patients were less likely to have a SCS infection (HR, 0.974; 95% CI: 0.962-0.986; p-value < 0.0001). CONCLUSIONS: The approximate 3% devicerelated infection rate within 12-months of SCS implant determined from a large administrative database further emphasizes the need for improvement in SCS infection control practices. Based on these results, research is warranted on methods to limit SCS infection rates in patients with a lumbar disk disease or a history of prior all-cause infection. Further research is needed to evaluate these patient factors in a prospective manner for SCS.