早期骶神经刺激器取出术围手术期危险因素的识别:一项单中心回顾性队列研究。

Identification of Perioperative Risk Factors for Early Sacral Nerve Stimulator Explantation: A Single-Center Retrospective Cohort Study.

作者信息

Murin Peyton J, Murin Patrick J, Lima de Mendonça Yara, Martins Yuri Chaves

机构信息

Department of Neurology, Saint Louis University School of Medicine, St. Louis, MO 63104, USA.

Department of Psychology, Rhodes College, Memphis, TN 38112, USA.

出版信息

J Clin Med. 2025 Mar 29;14(7):2363. doi: 10.3390/jcm14072363.

Abstract

Sacral nerve stimulators (SNSs) can be an effective treatment for urinary incontinence. However, with a failure rate of up to 50%, an explantation rate of up to 16%, and a cost of ~USD 10,000 per implant, identification of patients at high risk for explantation is necessary to improve patient satisfaction and reduce the economic burden on the healthcare system. The objective of this retrospective cohort study was to determine predictors of SNS explantation within the first two years of device placement. The MOVER database was queried for patients with a SNS and at least two years of follow-up (n = 54). Multivariate logistic regression was performed to assess risk factors for explantation. Factor optimization was used to eliminate factors with limited predictive value. The model displayed excellent performance with an AUC of 0.93 (95% CI: 0.78-1.00) and an f1-score of 0.81. Female sex (OR: 3.75; CI: 3.71-3.79), malignancy (OR: 3.14; CI: 3.10-3.18), ASA score (OR: 2.53; CI: 2.50-2.57), peripheral neuropathy (OR: 2.04: CI: 2.01-2.07), alcohol use (OR: 1.98; CI: 1.96-2.01), and length of stay (OR: 1.47; CI: 1.45-1.49) displayed statistically significant increased risk of explantation. Atrial fibrillation (OR: 0.36; CI: 0.35-0.36) and chronic kidney disease (OR: 0.54; CI: 0.53-0.54) were included in the model but conferred decreased risk of explantation. Patient ASA score and a medical history of malignancy, peripheral neuropathy, and alcohol use are possible novel risk factors for SNS explantation.

摘要

骶神经刺激器(SNSs)可有效治疗尿失禁。然而,其失败率高达50%,取出率高达16%,每次植入成本约10,000美元,因此识别高取出风险患者对于提高患者满意度和减轻医疗系统经济负担十分必要。这项回顾性队列研究的目的是确定在设备植入的头两年内SNS取出的预测因素。在MOVER数据库中查询了有SNS且至少随访两年的患者(n = 54)。进行多因素逻辑回归以评估取出的风险因素。使用因素优化来消除预测价值有限的因素。该模型表现出色,曲线下面积(AUC)为0.93(95%置信区间:0.78 - 1.00),F1分数为0.81。女性(比值比:3.75;置信区间:3.71 - 3.79)、恶性肿瘤(比值比:3.14;置信区间:3.10 - 3.18)、美国麻醉医师协会(ASA)评分(比值比:2.53;置信区间:2.50 - 2.57)、周围神经病变(比值比:2.04;置信区间:2.01 - 2.07)、饮酒(比值比:1.98;置信区间:1.96 - 2.01)和住院时间(比值比:1.47;置信区间:1.45 - 1.49)显示取出风险有统计学显著增加。心房颤动(比值比:0.36;置信区间:0.35 - 0.36)和慢性肾脏病(比值比:0.54;置信区间:0.53 - 0.54)被纳入模型,但取出风险降低。患者的ASA评分以及恶性肿瘤、周围神经病变和饮酒病史可能是SNS取出的新风险因素。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0cf1/11989564/fb868fea5348/jcm-14-02363-g001.jpg

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