Risk factors for explantation due to infection after sacral neuromodulation: a multicenter retrospective case-control study

• Published in: American journal of obstetrics and gynecology 2018-07, Vol.219 (1), p.78.e1-78.e9
• Main Authors: Myer, Emily N.B., Petrikovets, Andrey, Slocum, Paul D., Lee, Toy Gee, Carter-Brooks, Charelle M., Noor, Nabila, Carlos, Daniela M., Wu, Emily, Van Eck, Kathryn, Fashokun, Tola B., Yurteri-Kaplan, Ladin, Chen, Chi Chiung Grace
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anti-Bacterial Agents - therapeutic use; Case-Control Studies; Device Removal - statistics & numerical data; explant; Fecal Incontinence - therapy; Female; Humans; infection; Logistic Models; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Multivariate Analysis; overactive bladder; Prosthesis-Related Infections - epidemiology; Prosthesis-Related Infections - therapy; Retrospective Studies; Risk Factors; sacral nerve stimulation; sacral neuromodulation; Sacrum; Spinal Nerve Roots; Spinal Nerves; Staphylococcal Infections - epidemiology; Staphylococcus aureus; Transcutaneous Electric Nerve Stimulation; Urinary Bladder, Overactive - therapy; Urinary Retention - therapy
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2018.04.005

Sacral neuromodulation is an effective therapy for overactive bladder, urinary retention, and fecal incontinence. Infection after sacral neurostimulation is costly and burdensome. Determining optimal perioperative management strategies to reduce the risk of infection is important to reduce this burden. We sought to identify risk factors associated with sacral neurostimulator infection requiring explantation, to estimate the incidence of infection requiring explantation, and identify associated microbial pathogens. This is a multicenter retrospective case-control study of sacral neuromodulation procedures completed from Jan. 1, 2004, through Dec. 31, 2014. We identified all sacral neuromodulation implantable pulse generator implants as well as explants due to infection at 8 participating institutions. Cases were patients who required implantable pulse generator explantation for infection during the review period. Cases were included if age ≥18 years old, follow-up data were available ≥30 days after implantable pulse generator implant, and the implant was performed at the institution performing the explant. Two controls were matched to each case. These controls were the patients who had an implantable pulse generator implanted by the same surgeon immediately preceding and immediately following the identified case who met inclusion criteria. Controls were included if age ≥18 years old, no infection after implantable pulse generator implant, follow-up data were available ≥180 days after implant, and no explant for any reason 180 days after implant. Fisher exact test (for categorical variables) and Student t test (for continuous variables) were used to test the strength of the association between infection and patient and surgery characteristics. Significant variables were then considered in a multivariable logistic regression model to determine risk factors independently associated with infection. Over a 10-year period at 8 academic institutions, 1930 sacral neuromodulator implants were performed by 17 surgeons. In all, 38 cases requiring device explant for infection and 72 corresponding controls were identified. The incidence of infection requiring explant was 1.97%. Hematoma formation (13% cases, 0% controls; P = .004) and pocket depth of ≥3 cm (21% cases, 0% controls; P = .031) were independently associated with an increased risk of infection requiring explant. On