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Obesity Trends Amongst Hospitalized Patients with Spinal Cord Stimulator Implants

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.

Graphic Abstract

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Fig. 1

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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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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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  • DOI: https://doi.org/10.1007/s12325-020-01487-8

Keywords

  • Healthcare utilization
  • Obesity
  • Overweight
  • SCS
  • Spinal cord stimulator therapy