Department of Urology, University of Michigan, Ann Arbor, Michigan 48109-5330, USA.
J Urol. 2011 Mar;185(3):970-5. doi: 10.1016/j.juro.2010.10.060. Epub 2011 Jan 19.
Little is known about outcomes of sacral neuromodulation in the general community, with published reports to date limited to case series or randomized, controlled trials. The goal of this analysis was to identify the national sacral neuromodulation test phase success rate and patient factors that contribute to success.
Medical claims data were obtained from a 5% sample of Medicare beneficiaries (1997 to 2007) and from employees of 25 large (Fortune 500) companies (Ingenix®, 2002 to 2007). Using billing codes for the sacral neuromodulation procedure, success was defined as progressing from test phase (percutaneous or staged) to battery implantation. The rate of success was compared based on age, race, gender and diagnosis.
In the Medicare sample 358 patients received percutaneous test stimulation and 1,132 underwent 2-stage lead placement, of whom 45.8% and 35.4%, respectively, underwent subsequent battery implantation. In the privately insured sample there were 266 percutaneous procedures and 794, 2-stage procedures. Percutaneous procedures were followed by battery placement in 24.1% of cases, whereas 50.9% of staged procedures resulted in battery implantation. Gender was the only consistent predictor of success, with female patients demonstrating higher success rates in each data set.
The sacral neuromodulation success rates in these data sets are inferior to those published in case series and small randomized, controlled trials. Women had significantly better results than men and privately insured individuals had better results than those with Medicare, indicating a potential age effect.
目前对于普通人群中骶神经调节的结果知之甚少，迄今为止发表的报告仅限于病例系列或随机对照试验。本分析的目的是确定全国骶神经调节测试阶段的成功率以及有助于成功的患者因素。
从 Medicare 受益人的 5%样本（1997 年至 2007 年）和 25 家大公司（Ingenix®，2002 年至 2007 年）的员工中获得医疗索赔数据。使用骶神经调节程序的计费代码，成功定义为从测试阶段（经皮或分期）进展到电池植入。根据年龄、种族、性别和诊断比较成功率。
在 Medicare 样本中，358 名患者接受了经皮测试刺激，1132 名患者接受了 2 期导丝放置，其中分别有 45.8%和 35.4%随后进行了电池植入。在私人保险样本中，有 266 例经皮手术和 794 例、2 期手术。经皮手术中有 24.1%随后进行了电池放置，而 50.9%的分期手术则进行了电池植入。性别是唯一一致的成功预测因素，女性患者在每个数据集的成功率都更高。
这些数据集的骶神经调节成功率低于病例系列和小型随机对照试验中发表的成功率。女性的结果明显优于男性，私人保险患者的结果优于 Medicare 患者，表明存在潜在的年龄效应。
