Speltz Paiz Rebecca, Kaizer Alexander, Jain Sejal V, Darrow David P, Shankar Hariharan, Goel Vasudha
Department of Anesthesiology, University of Minnesota, Minneapolis, MN, USA.
Colorado School of Public Health, Aurora, CO, USA.
Neuromodulation. 2023 Jul;26(5):1095-1101. doi: 10.1016/j.neurom.2022.06.001. Epub 2022 Aug 9.
Lead migration (LM) after spinal cord stimulation (SCS) implantation surgery is the most common device-related complication. Our study of lead and implantable pulse generator (IPG) migration using a large administrative claims data base aims to understand rates, risk factors, and outcomes after SCS implantation.
This retrospective cohort study used the IBM® MarketScan® (Armonk, NY) Commercial and Medicare Supplemental Databases from 2016 to 2018. Adult patients who underwent SCS surgical procedures with at least 90 days of follow-up were identified using Current Procedural Terminology (CPT®) codes. Patients with LM and IPG migration after SCS surgery were identified using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10 CM) codes. Patients who underwent revision surgery after SCS implantation were identified using the CPT codes and ICD-10 CM codes. In addition, patient characteristics associated with LM or IPG migration, the temporal relationship of migration diagnosis, and revision surgery were evaluated in the cohort. Continuous outcomes were compared between groups using the two-sample Student t-test. The Fisher exact test was used to compare categorical outcomes between groups.
A total of 7322 patients (64.4% percutaneous SCS) underwent SCS surgery during the study period. A total of 141 patients (1.9%) had LM or IPG migration. Of those, 116 patients (1.6%) had LM only; 18 patients (0.2%) had IPG migration; and seven patients (0.1%) had LM and IPG migration. The mean duration for migration diagnosis after initial SCS implantation was 168 (±163.1) days. The mean duration to revision surgery after the migration diagnosis was 12.3 (±35.2) days only. Most patients with migration (105, 74.5%) underwent revision surgery. Only younger age (p = 0.02) was associated with migration in this study.
LM and pulse generator migration that required revision surgery occurred in a small proportion of patients who underwent SCS surgical procedures.
脊髓刺激（SCS）植入手术后的导线移位（LM）是最常见的与设备相关的并发症。我们使用大型管理索赔数据库对导线和植入式脉冲发生器（IPG）移位进行研究，旨在了解SCS植入后的发生率、风险因素及结局。
这项回顾性队列研究使用了IBM® MarketScan®（纽约州阿蒙克）2016年至2018年的商业和医疗保险补充数据库。使用当前操作术语（CPT®）编码确定接受SCS手术且至少随访90天的成年患者。使用国际疾病分类第10版临床修订本（ICD-10 CM）编码确定SCS手术后发生LM和IPG移位的患者。使用CPT编码和ICD-10 CM编码确定SCS植入后接受翻修手术的患者。此外，在队列中评估与LM或IPG移位相关的患者特征、移位诊断的时间关系以及翻修手术情况。使用两样本Student t检验比较组间的连续结局。使用Fisher精确检验比较组间的分类结局。
在研究期间，共有7322例患者（64.4%为经皮SCS）接受了SCS手术。共有141例患者（1.9%）发生了LM或IPG移位。其中，116例患者（1.6%）仅发生LM；18例患者（0.2%）发生IPG移位；7例患者（0.1%）同时发生LM和IPG移位。初次SCS植入后至移位诊断的平均持续时间为168（±163.1）天。移位诊断后至翻修手术的平均持续时间仅为12.3（±35.2）天。大多数发生移位的患者（105例，74.5%）接受了翻修手术。在本研究中，仅年龄较小（p = 0.02）与移位相关。
在接受SCS手术的患者中，一小部分发生了需要翻修手术的LM和脉冲发生器移位。
