Rate of Sacral Neuromodulation Explant Due to Surgical Site Infection

INTRODUCTION: Sacral neuromodulation (SNM) is a well-established, minimally invasive therapy for the treatment of bowel and urinary dysfunction. While overall complication rates are low, SNM device placement carries the risk of postoperative surgical site infection (SSI), a complication which often necessitates device explant. This can subsequently result in the return of bothersome symptoms, as well as increased morbidity and healthcare costs. The primary objective was to compare the rate of device explant due to SSI with the rate of the explant due to other causes. OBJECTIVE: The primary objective was to compare the rate of device explant due to SSI with the rate of the explant due to other causes. METHODS: This was a retrospective cohort study utilizing the Premier Healthcare Database. Patients were identified as having undergone SNM placement and explant between January 2016 and March 2020 using CPT codes. The patients were grouped by those who had an associated ICD-10 code for SSI at the time of explant and those who did not. Patient characteristics, surgical information, and postoperative complications within 3 months and 1 year were collected. Antibiotic administration was categorized as cephalosporins, current AUA guidelines (Gram positive + broad Gram-negative coverage), or Other. RESULTS: The sample included 826 patients that underwent SNM implant and explant (Table 1). Of those, 61 patients (7.4%) had an ICD-10 code for SSI at the time of their explant procedure, while 765 (92.6%) did not. The groups were statistically similar based on demographic and preoperative characteristics. The groups differed significantly by the type of antibiotic administered at the time of implant (p=0.03). Explants performed due to non-SSI causes were more likely to occur in the first 3 months following placement (69.8% vs. 55.7%, p=0.03). CONCLUSIONS: Patients are more likely to have a SNM device explanted due to causes other than SSI, especially within the first 3 months after implant.