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

Background: 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. Methods: 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. Results: 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. Conclusions: Patient ASA score and a medical history of malignancy, peripheral neuropathy, and alcohol use are possible novel risk factors for SNS explantation.