Factors predicting complications after sacral neuromodulation in children
Molly E. Fuchs, MD1, Peter L. Lu, MD1, Stephanie J. Vyrostek, RN, BSN1, Steven Teich, MD2, Seth A. Alpert, MD1.
1Nationwide Children's Hospital, Columbus, OH, USA, 2Carolinas HealthCare System, Charlotte, NC, USA.
Introduction: Sacral neuromodulation (SNM) has been shown to improve refractory bowel and bladder dysfunction in children and is gaining acceptance with an increased body of literature. Post-operative infection, lead migration and lead malfunction are known complications of SNM with a range of frequencies reported in the literature. Few studies have studied potential risk factors for such complications in pediatric SNM. The purpose of this study is to identify which, if any, variables are associated with post-operative wound infection or lead complications in these patients.
Methods: A review of all patients undergoing SNM with an implantable pulse generator at our institution was performed. Post-operative infection, lead migration, lead breakage and need for reoperation were recorded in an IRB-approved prospective patient database. We collected demographic information including age, gender, BMI and indication for the procedure. We defined indication for procedure as either primarily bowel, or primarily bladder symptoms. Multivariate analysis was used to determine any associations between pre-operative factors and post-operative complications.
Results: A total of 63 children (34 females, 29 males) underwent SNM from 2012 - 2015. Mean age at surgery was 11.5 yrs (4.8 - 19.8) and mean BMI was 51 (1 - 99). SNM was placed for primarily bowel symptoms in 31 patients (49%) and for primarily bladder symptoms in 32 (51%). Fifteen children (24%) required reoperation. Eleven children (17.4%) had lead migration. Wound infection occurred in 5 (8%) patients. We did not find statistically significant associations between patient age, gender or BMI and need for reoperation, wound infection or lead migration. Specifically, in our series, those with low BMI had no increased risk for lead complications (p=0.115). However, while indication for procedure was not a significant factor for lead reoperation or wound infection, there was a significant increase in lead migration in the children who underwent SNM for primarily bladder symptoms (p=0.0034).
Conclusions: Using a large prospective patient database of children who have undergone SNM, we found that those whose primary indication for surgery was refractory bladder symptoms had an increased risk of lead migration. In our cohort, there was no association between patient BMI, gender or age with any post-operative complication. Further studies and longer follow-up may be helpful to identify if any of these or other factors predict complications after pediatric SNM.
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