1506. Characterizing Perioperative Outcomes Following Spinal Cord Stimulator Implantation for Complex Regional Pain Syndrome

Authors: Michael Martini; Sean Neifert, BS; Lawrence Zeldin, BS; David Kim, BS; Jonathan Gal, MD; John Caridi, MD (New York, NY)

Introduction:

Complex Regional Pain Syndrome (CRPS) is a multifaceted disorder proposed to arise from an abnormal tissue injury response. CRPS features signs of neurogenic inflammation, maladaptive neuroplasticity, and vasomotor dysfunction, which result in chronic, severe pain and disability. Spinal cord stimulation (SCS) is an efficacious treatment for several chronic pain conditions and has been reported to improve pain and quality of life in patients with CRPS. Little information exists, however, regarding the perioperative outcomes of CRPS patients undergoing surgical implantation of a spinal cord stimulator.

Methods:

Patients were included if they underwent a SCS procedure at our institution between 2008-2016 for chronic pain. Cases were excluded if the procedure involved stimulator removal or if it was an outpatient procedure. Linear regression assessed the effect of CRPS and other clinical variables on perioperative outcome measures.

Results:

A total of 81 inpatient SCS implantation cases for chronic pain were included, with 9 of these patients (11.1%) receiving SCS for CRPS. There were no perioperative complications or mortalities reported with these cases. At the univariate level, preoperative diagnosis of CRPS was associated with significantly longer hospitalizations (coefficient=1.88; 95%CI 0.60-3.15; p=0.0047), increased intraoperative blood loss (coefficient=70.21; 95%CI 11.98-128.44; p=0.0188), and higher total costs (coefficient=+$20,660; 95%CI $9,640-31,679; p=0.0004). In multivariate models controlling for age, gender, race, ASA score, and insurance payer type, CRPS remained a significant predictor of longer hospitalizations (coefficient=1.88; 95%CI 0.32-3.44; p=0.0189) and higher total costs (coefficient=+$23,328; 95%CI $9,124-34,018; p=0.0009). Age (p=0.0178) and total intraoperative fentanyl administration (p=0.0111) were also significant predictors of higher total costs in the multivariate model.

Conclusion:

Our data suggest that CRPS is associated with significantly longer hospitalizations and total costs following inpatient SCS implantation. These findings support the need for future prospective investigations examining the risk and outcome profiles for SCS procedures in this unique patient population.