Introduction: Spinal cord stimulators (SCS) are an effective treatment for a variety of chronic pain conditions. National databases have not been used to establish the rate of complications following SCS implantation and removal. Therefore, our aim was to use the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) to estimate the prevalence of 30-day postoperative complications following SCS implantation and removal.
Methods: Patients who underwent SCS implantation/replacement (CPT codes: 63650, 63655, 63663, 63664) and removal (CPT codes: 63661, 63662) were obtained from the 2005-2015 ACS-NSQIP. The prevalence of 30-day postoperative complications was determined. Multivariable logistic regression was used to identify risk factors for at least one complication.
Results: A total of 145 cases of SCS surgery (90 implantation/replacement, 55 removal) were identified. The prevalence of at least one complication was significantly lower for SCS implantation/replacement when compared to SCS removal (5.56% vs. 18.18%; p=0.02). However, there was not a significant difference in the odds of complications after controlling for covariates in multivariable models. Longer duration of surgery (Odds Ratio [OR]: 1.69; 95% Confidence Interval [CI]: 1.19-2.40; p=0.004) was the only significant predictor for at least one complication.
Conclusions: The overall prevalence of any complication within 30 days of SCS removal is higher than for implantation/replacement on univariate analysis, but not on multivariable analysis. Longer duration of surgery was the only risk factor for higher likelihood of complications. Further research is necessary with a larger sample to better characterize the postoperative course following SCS surgeries.
Patient Care: This study attempts to characterize the major differences in postoperative complications for patients undergoing spinal cord stimulator implantation and removal. Our study highlights the limited conclusions that can be made from the small sample of these procedures from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Future research using a larger size is necessary in order to draw meaningful conclusions on the current status of postoperative outcomes following spinal cord stimulator surgery.
Learning Objectives: At the conclusion of this session, participants should be able to: 1) describe differences in perioperative characteristics related to spinal cord stimulator implantation and removal; 2) understand general information on the prevalence of and risk factors for postoperative complications following spinal cord stimulator implantation and removal; and 3) recognize limitations of current data on spinal cord stimulator surgery within the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP).