Management and Cost of Spinal Cord Stimulator Explants due to Infection.

Objectives: Explants due to infected spinal cord stimulation (SCS) devices are a significant concern, leading to complex care needs and high costs. This study aimed to evaluate the cost of explant and subsequent management in patients in cases of device infection.

Materials and methods: This retrospective study analyzed data over eight years (2014-2022) at a UK neuromodulation center. Cases of explant due to infection were identified from a departmental data base. Data were collected from electronic clinical care records. Patient admission costs were retrieved from the accounting services using cost pool groups. Electrical neuromodulation equipment costs were obtained from National Health Service England data bases specific to each manufacturer.

Results: Among 215 explants, 23 were attributed to infection, with 22 of 23 involving the implantable pulse generator. A total of 16 of 23 cases (70%) met the criteria for deep surgical site infection, whereas seven cases occurred after 90 days. Microbiological cultures confirmed infections in nine of 23 cases (39%). In five cases, explant was performed owing to pus observed around the hardware during revision surgery that grew no bacteria after culture. The median time to explant due to infection was 42 days [29-356]. The median cost of explant and follow-up care was £16,957 [£5,243-£26,823], with higher costs observed when reimplantation was attempted (£26,172 [£18,753-£37,427]). Reimplantation of the neuromodulation device was attempted in 13 of 23 patients (57%). Successful reimplant was limited and achieved in only eight of 13 cases (62%). The median time to reimplantation was 193 days [181-658] postexplant, and the reinfection rate in those who were reimplanted was 30%. Ultimately, a successful reimplant was achieved in 35% of patients (eight of 23) after explant due to suspected infection.

Conclusion: The findings emphasize the need for preventive strategies to mitigate infection risk and reduce costs. Improved understanding of infection management may ultimately help reduce the clinical and economic burden of SCS infections. Attempts to reestablish the therapy need careful consideration and counseling of patients.