Incidence, Reasons, and Predictors of Explantation of Sacral Neuromodulator: a Single-Institution Experience
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SURGERY
Incidence, Reasons, and Predictors of Explantation of Sacral Neuromodulator: a Single-Institution Experience Woojin Chong 1,2
&
Peiying Hua 3 & Bertille Gaigbe-Togbe 2 & Jessica Overbey 3
Accepted: 24 August 2020 # Springer Nature Switzerland AG 2020
Abstract 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 personmonth 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. Keywords Fecal incontinence . Neurostimulator explantation . Sacral nerve stimulation . Urinary incontinence
Introduction Conference Presentations The abstract was presented at the Society of Gynecologic Surgeons 45th Annual Scientific Meeting in 2019 at Tucson, AZ. This article is part of the Topical Collection on Surgery * Woojin Chong [email protected] 1
Inspira Health Urogynecology, Vineland/Mullica Hill, NJ, USA
2
Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
3
Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
Sacral neuromodulation (SNM) has been utilized for chronic urinary voiding dysfunction and chronic fecal incontinence. The SNM was approved in 1997 by the FDA for the treatment
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