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Obesity Trends Amongst Hospitalized Patients with Spinal Cord Stimulator Implants

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Abstract

Introduction

Chronic pain remains an important public health problem as it continues to increase healthcare-related cost. Comorbidities like obesity have been associated with efficacy of spinal cord stimulator (SCS) therapy and worse outcomes. The goal of this study is to investigate the trends of obesity amongst hospitalized patients with SCS therapy as well as healthcare utilization outcomes.

Methods

Using the International Classification of Diseases (ICD) ninth and tenth procedure and diagnosis code, we investigated the National Inpatient Sample (NIS) for patients with SCS implants between 2011 and 2015. Patients received a diagnosis of obesity based on the following categories: class I, II and III obesity. Age, gender, and comorbid conditions of patients with obesity were matched 1:1 on propensity score to those without obesity diagnosis. Our primary outcome was defined as trend of obesity diagnosis. Our secondary outcome, healthcare utilization, included in-hospital cost, length of stay, and discharge location.

Results

Between 2011 and 2015, a total of 3893 patients with SCS implants were identified (average age 56 ± 15 years, 58% female, 0.70 ± 1.1 Charlson Comorbidity Index, CCI). Of this cohort, 640 patients were identified as obese. The proportion of patients with obesity diagnosis increased significantly from 13.75% in 2011 to 19.36% in 2015 (p < 0.001). After 1:1 matching on propensity score, 597 patients with obesity were successfully matched to 597 patients without obesity. The total hospital cost for SCS patients with obesity (median $104,845, IQR $74,648–144,292) was not significantly different from patients without obesity diagnosis (median $111,092, IQR $68,990–145,459) (p = 0.161).

Conclusions

The data from our study suggests that there is an increasing rate of obesity diagnosis amongst patients with SCS therapy. However, there was no difference in healthcare utilization between patients with and without obesity. Additional studies may provide more insight into our findings.

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Acknowledgements

Funding

No funding or sponsorship was received for this study or publication of this article.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. All authors critically revised the manuscript, interpreted the results, and performed a critical review of the manuscript for intellectual content.

Disclosure

Vwaire Orhurhu, Faizan Khan, Mariam Salisu Orhurhu, Emeka Agudile, Ivan Urits, Jamal Hasoon, Khurram Owais, Robert Chu, Dotun Ogunsola, Omar Viswanath, Cyrus Yazdi, Jay Karri, Samir Hirji and Jatinder Gill have nothing to disclose. Thomas Simopoulos has served as a speaker for Boston Scientific, St. Jude, and Nevro Corp.

Compliance with Ethic Guidelines

The NIS database is a de-identified database that consists of a collection of billing and diagnostic codes used by participating hospitals with the goal of quality control, population monitoring, and tracking procedures. The NIS does not require institutional review board (IRB) approval or exempt determination.

Data Availability

The dataset analyzed during the current study are available in the NIS repository by the Agency for Healthcare Research and Quality, http://www.hcup-us.ahrq.gov, or from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Anesthesia, Critical Care and Pain Medicine, Division of Pain, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Vwaire Orhurhu & Mariam Salisu Orhurhu

  2. Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Faizan Khan

  3. Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Emeka Agudile

  4. Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Ivan Urits, Jamal Hasoon, Cyrus Yazdi, Jatinder Gill & Thomas Simopoulos

  5. Department of Anesthesiology, Critical Care and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Khurram Owais

  6. Johns Hopkins School of Medicine, Baltimore, MD, USA

    Robert Chu

  7. Department of Epidemiology and Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA

    Dotun Ogunsola

  8. Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA

    Omar Viswanath

  9. Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA

    Jay Karri

  10. Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Samir Hirji

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  1. Vwaire Orhurhu
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Correspondence to Vwaire Orhurhu.

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Orhurhu, V., Khan, F., Salisu Orhurhu, M. et al. Obesity Trends Amongst Hospitalized Patients with Spinal Cord Stimulator Implants. Adv Ther 37, 4614–4626 (2020). https://doi.org/10.1007/s12325-020-01487-8

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