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

Autor: Tola Fashokun, Andrey Petrikovets, Ladin A. Yurteri-Kaplan, N. Noor, Emily N.B. Myer, Kathryn Van Eck, Chi Chiung Grace Chen, Daniela M. Carlos, P. Slocum, Charelle M. Carter-Brooks, Emily Wu, Toy G. Lee
Rok vydání: 2018
Předmět:
Adult
Male
Methicillin-Resistant Staphylococcus aureus
medicine.medical_specialty
Sacrum
Staphylococcus aureus
Prosthesis-Related Infections
Postoperative hematoma
030232 urology & nephrology
03 medical and health sciences
symbols.namesake
0302 clinical medicine
Hematoma
Risk Factors
Medicine
Fecal incontinence
Humans
Fisher's exact test
Device Removal
Aged
Retrospective Studies
030219 obstetrics & reproductive medicine
business.industry
Urinary retention
Urinary Bladder
Overactive
Obstetrics and Gynecology
Odds ratio
Middle Aged
Staphylococcal Infections
Urinary Retention
medicine.disease
Surgery
Anti-Bacterial Agents
Logistic Models
Spinal Nerves
Overactive bladder
Case-Control Studies
Multivariate Analysis
symbols
Transcutaneous Electric Nerve Stimulation
Female
Implant
medicine.symptom
business
Spinal Nerve Roots
Fecal Incontinence
Zdroj: American journal of obstetrics and gynecology. 219(1)
ISSN: 1097-6868
Popis: 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 reason180 days from implant. Controls may have had an explant for reasons other than infection at180 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 multivariable regression analysis controlling for significant variables, both hematoma formation (P = .006) and pocket depth ≥3 cm (P = .020, odds ratio 3.26; 95% confidence interval, 1.20-8.89) remained significantly associated with infection requiring explant. Of the 38 cases requiring explant, 32 had cultures collected and 24 had positive cultures. All 5 cases with a hematoma had a positive culture (100%). Of the 4 cases with a pocket depth ≥3 cm, 2 had positive cultures, 1 had negative cultures, and 1 had a missing culture result. The most common organism identified was methicillin-resistant Staphylococcus aureus (38%).Infection after sacral neuromodulation requiring device explant is low. The most common infectious pathogen identified was methicillin-resistant S aureus. Demographic and health characteristics did not predict risk of explant due to infection, however, having a postoperative hematoma or a deep pocket ≥3 cm significantly increased the risk of explant due to infection. These findings highlight the importance of meticulous hemostasis as well as ensuring the pocket depth is3 cm at the time of device implant.
Databáze: OpenAIRE
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