(Poster 66) Rate of Sacral Neuromodulation Explantation in Patients with Chronic Pain

Objectives: Assess the rate of sacral neuromodulation (SNM) explantation in patients with chronic pain diagnoses compared to non-pain patients.

Methods: This is a retrospective cohort study utilizing the TriNetX Research Network platform using years 2006 to 2024. TriNetX is a global federated network of electronic medical record data from 95 health care organizations and provides a de-identified EMR database for up to 128 million patients. Adult (18 years or older) female patients were included in the study if they had overactive bladder (ICD-10 code N32.81) or urge incontinence (ICD-10 code N39.41) and had sacral neurostimulator insertion (CPT code 64590) from 2010 to present. If subjects had the device removed for surgical site infection, these patients were excluded from the study. Pain diagnoses included; interstitial cystitis and bladder pain syndrome (ICD-10 codes N30.1, N30.10, N30.11, and R39.82), pelvic and perineal pain (ICD-10 code R10.2) and chronic musculoskeletal pain (ICD-10 codes M79.7XX and M54XX). The control group included all subjects without any of the pain diagnoses. The primary outcome was the rate of neurostimulator device revision or removal (CPT 64595) within 2 years in the absence of surgical site infection.

Results: There was a significant difference in the rates of SNM explantation in patients with interstitial cystitis/bladder pain syndrome 138/1199 (11.51%), perineal and pelvic pain 346/3129 (11.06%), and chronic musculoskeletal pain 629/6794 (9.26%) in comparison to our control group 496/6690 (7.41%) (p < 0.01 for all comparisons). The Kaplan Meier curves for each procedure are shown in figure 1. There was no significant difference in the risk of explantation between each of our pain cohorts . After combining the pain cohorts together, there continued to be a significant difference between the cohort and the control population ; 9.33% and 7.41% respectively (p < 0.01).

Conclusions: Our study suggests that chronic pain syndromes have a significantly higher rate of SNM explantation than patients without chronic pain syndromes. A strength of our study is the large number of subjects from a wide variety of medical centers and surgeons. Additionally, by excluding patients with a surgical site infection we limited the effect that removal for infectious etiology impacted our study results. The study is limited by the administrative nature of the database and the retrospective nature of the study. This limits our ability to definitively state the indication for device removal. Additionally, we suspect that the observed difference after combining the cohorts was less than we expected because there was overlap between the cohorts’ diagnoses. Our study offers possible clinical guidance for clinicians during surgical counseling for sacral neuromodulation.