Background: Sacral nerve stimulators (SNSs) can be an effective treatment for urinary incontinence. However, with a failure rate of up to 50%, an explantation rate of up to 16%, and a cost of ~USD 10,000 per implant, identification of patients at high risk for explantation is necessary to improve patient satisfaction and reduce the economic burden on the healthcare system. The objective of this retrospective cohort study was to determine predictors of SNS explantation within the first two years of device placement. Methods: The MOVER database was queried for patients with a SNS and at least two years of follow-up (n = 54). Multivariate logistic regression was performed to assess risk factors for explantation. Factor optimization was used to eliminate factors with limited predictive value. Results: The model displayed excellent performance with an AUC of 0.93 (95% CI: 0.78–1.00) and an f1-score of 0.81. Female sex (OR: 3.75; CI: 3.71–3.79), malignancy (OR: 3.14; CI: 3.10–3.18), ASA score (OR: 2.53; CI: 2.50–2.57), peripheral neuropathy (OR: 2.04: CI: 2.01–2.07), alcohol use (OR: 1.98; CI: 1.96–2.01), and length of stay (OR: 1.47; CI: 1.45–1.49) displayed statistically significant increased risk of explantation. Atrial fibrillation (OR: 0.36; CI: 0.35–0.36) and chronic kidney disease (OR: 0.54; CI: 0.53–0.54) were included in the model but conferred decreased risk of explantation. Conclusions: Patient ASA score and a medical history of malignancy, peripheral neuropathy, and alcohol use are possible novel risk factors for SNS explantation.

Background: Spinal cord stimulators can offer an effective treatment in chronic pain refractory to conventional medical management. However, with a failure rate of up to 44% and an annual explantation rate of 6–9%, there is a need to better identify patients at high risk for therapeutic failure. The objective of this retrospective cohort study was to determine predictors of early SCS explantation following device placement. Methods: The Medical Informatics Operating room Vitals and Events Repository database was queried for patients with a spinal cord stimulator and at least two years of follow-up (n = 56). A multivariate logistic regression was fitted. Recursive factor elimination with cross-validation and L1 penalization were used to reduce the number of predictors and minimize the risk of overfitting. The model was used to predict risk factors for explantation, odds ratio (OR), 95% confidence interval (CI), and false discovery rate-adjusted p-value. Results: The final model displayed adequate performance with an average precision of 0.769. Sleep disorders were identified as a statistically significant predictor of SCS explantation (OR: 3.88, CI: 1.36–11.04, FDR p-value: 0.0497). Conclusions: While further prospective studies are needed, our study indicates that sleep disorders are a risk factor for spinal cord stimulator explantation and should be considered during pre-operative evaluation.

Background: Sacral nerve stimulators (SNS) can be an effective treatment for urinary incontinence. However, with a failure rate of up to 50%, an explantation rate of up to 16%, and a cost of ~US$10,000 per implant, identification of patients at high risk for explantation is necessary to improve patient satisfaction and reduce the economic burden on the healthcare system. The objective of this retrospective cohort study was to determine predictors of SNS explantation within the first two years of device placement. Methods: The MOVER database was queried for patients with a SNS and at least two years of follow up (n = 54). Multivariate logistic regression was performed to assess risk factors for explantation. Factor optimization was used to eliminate factors with limited predictive value. Results: The model displayed excellent performance with an AUC of 0.93 and an f1-score of 0.81. Malignancy (OR: 3.88; CI: 3.84 – 3.93), female sex (OR: 3.72; CI: 3.68 – 3.76), ASA score (OR: 2.39; CI: 2.36 – 2.42), alcohol use (OR: 2.08; CI: 2.06 – 2.08), length of stay (OR: 1.92; CI: 1.90 – 1.94), peripheral neuropathy (OR: 1.86: CI: 1.83 – 1.88), and low back pain (OR: 1.82; CI: 1.79 – 1.84) displayed statistically significant increased risk of explantation. Atrial fibrillation (OR: 0.38; CI: 0.37 – 0.38) and chronic kidney disease (OR: 0.47; CI: 0.47 – 0.48) were included in the model but conferred decreased risk of explantation. Conclusions: Patient’s ASA score, medical history of malignancy, alcohol use, low back pain, and peripheral neuropathy are possible novel risk factors for SNS explantation.

Background: Spinal cord stimulators can offer an effective treatment in chronic pain refractory to conventional medical management. However, with a failure rate of up to 44% and an annual explant rate of 6-9%, there is a need to better identify patients at high risk of therapeutic failure. The objective of this retrospective cohort study was to determine predictors of early SCS explant following device placement. Methods: The Medical Informatics Operating room Vitals and Events Repository database was queried for patients with a spinal cord stimulator and at least two years of follow up (n = 56). A multivariate logistic regression was fitted. Recursive factor elimination and bootstrap validation were used to minimize risk of overfitting. The model was used to predict risk factors for explant, odds ratio (OR), and 95% confidence interval (CI). Results: The final model displayed good performance with a bootstrap mean Area Under the Receiver Operating Curve of 0.91 (bootstrap CI: 0.74 – 1.0) and bootstrap mean accuracy of 82.1% (bootstrap CI: 63.0% – 97.7%). Fibromyalgia (OR: 2.38; CI: 2.34 – 2.41), hyperlipidemia (OR: 2.24; CI: 2.20 – 2.27), sleep disorder (OR: 2.10; CI: 2.07 – 2.14), obesity (OR: 1.93; CI: 1.90 – 1.95), and irritable bowel syndrome (OR: 1.63; CI: 1.61 – 1.65) displayed statistically significant increased risk of explantation. Conclusions: A medical history of fibromyalgia, hyperlipidemia, sleep disorders, obesity, and irritable bowel syndrome are novel risk factors for spinal cord stimulator explantation. While further prospective studies are needed, our study would suggest these factors may be worth considering in pre-operative evaluation.