Xu Zhaomin, Fleming Fergal J, Justiniano Carla F, Becerra Adan Z, Boodry Courtney I, Aquina Christopher T, Temple Larissa K, Speranza Jenny R
Department of Surgery, University of Rochester Medical Center, Rochester, New York.
Department of Public Health Sciences, Division of Epidemiology, University of Rochester Medical Center, Rochester, New York.
Dis Colon Rectum. 2018 Jan;61(1):107-114. doi: 10.1097/DCR.0000000000000941.
There is a paucity of real-world data regarding surgeon utilization of sacral nerve stimulation for fecal incontinence compared with anal sphincteroplasty.
This study aims to examine trends in sacral nerve stimulation use compared with sphincteroplasty for fecal incontinence and surgeon-level variation in progression to implantation of the pulse generator.
This is a population-based study.
Patients with fecal incontinence between 2011 and 2014 in New York who underwent stage 1 of the sacral nerve stimulation procedure were selected. For the comparison with sphincteroplasty, patients with fecal incontinence who underwent anal sphincteroplasty between 2008 and 2014 were included.
The main outcomes after sacral nerve stimulation generator placement were unplanned 30-day admission, emergency department visit within 30 days, revision or explant of leads or generator, and 30-day mortality.
Six hundred twenty-one patients with fecal incontinence underwent a stage 1 procedure with 79.7% progressing to stage 2. There has been an increase in the number of sacral nerve stimulation cases per year as well as the number of surgeons performing the procedure. The rate of progression to stage 2 among patients treated by colorectal surgeons was 80.2% compared with 77.0% among those treated by noncolorectal surgeons. Among those who completed stage 2, there were 3 (0.5%) unplanned 30-day admissions, 24 (4.4%) emergency department visits within 30 days, and 0 mortalities within 30 days. Thirty-two (6.5%) patients had their leads or pulse generator revised or explanted. There was a significant decrease in annual sphincteroplasty cases and the number of providers performing the procedure starting in 2011.
We lacked data regarding patient and physician decision making and the severity of disease.
Sacral nerve stimulation for fecal incontinence is increasing in popularity with an increasing number of surgeons utilizing sacral nerve stimulation for fecal incontinence rather than sphincteroplasty. See Video Abstract at http://links.lww.com/DCR/A450.
与肛门括约肌成形术相比，关于外科医生使用骶神经刺激治疗大便失禁的真实世界数据较少。
本研究旨在探讨与括约肌成形术相比，骶神经刺激治疗大便失禁的使用趋势以及外科医生在脉冲发生器植入进展方面的差异。
这是一项基于人群的研究。
选取2011年至2014年在纽约接受骶神经刺激手术第一阶段的大便失禁患者。为了与括约肌成形术进行比较，纳入了2008年至2014年期间接受肛门括约肌成形术的大便失禁患者。
骶神经刺激发生器置入后的主要结局包括30天内非计划入院、30天内急诊就诊、导线或发生器的翻修或取出以及30天死亡率。
621例大便失禁患者接受了第一阶段手术，其中79.7%进展至第二阶段。每年骶神经刺激病例数以及实施该手术的外科医生数量均有所增加。结直肠外科医生治疗的患者进展至第二阶段的比例为80.2%，而非结直肠外科医生治疗的患者为77.0%。在完成第二阶段的患者中，有3例（0.5%）30天内非计划入院，24例（4.4%）30天内急诊就诊，30天内无死亡病例。32例（6.5%）患者的导线或脉冲发生器进行了翻修或取出。自2011年起，每年的括约肌成形术病例数及实施该手术的医疗人员数量显著减少。
我们缺乏关于患者和医生决策以及疾病严重程度的数据。
骶神经刺激治疗大便失禁越来越受欢迎，越来越多的外科医生使用骶神经刺激治疗大便失禁而非括约肌成形术。见视频摘要：http://links.lww.com/DCR/A450 。
