Abstract: PD54-12
Sources of Funding: none

Introduction

With the number of indications increasing for sacral neuromodulation (SNM), multiple surgical specialties are now performing the procedure. However, it is unknown what proportion of implants are being performed by each specialty. The level of training of those performing SNM implants has also never been studied. We aim to assess trends in Interstim® generator implants and subsequent revisions or removals performed in New York state._x000D_

Methods

The Statewide Planning and Research Cooperative System (SPARCS) is a comprehensive all payer data reporting system that collects patient level details on hospital and outpatient visits in New York State. We queried all SNM generator implantations from 2011 to 2014 (CPT code 94590) as well as device revision or removal (CPT codes 94585 and 94595).

Results

From 2011-2014, a total 1,454 implants were performed in NYS. 60.5%, 14.8%, and 19.2% were performed by urologists, gynecologists, and colorectal surgeons (CRS), respectively. 44% (408/931) of urology implants and 64% (146/228) gynecology implants were performed by Female Pelvic Medicine and Reconstructive Surgery (FPMRS) trained physicians. The number of cases performed by urologists decreased significantly in 2014 while CRS nearly doubled the number of implants performed each year from 2011 to 2013 (Figure 1). 8.5% of implants required subsequent revision or removal during this time period. There were no statistical differences in Interstim® revision or removal rates between implants performed by urologists (9.0%), gynecologists (10.1%), or CRS (5.4%, p=0.097). There was also no statistical difference in revision or removal rates when comparing implants performed by those with a fellowship in FPMRS (9.9%) and those without (11.4%, p=0.414).

Conclusions

In recent years, SNM implantation has been primarily performed by urologists in NYS. Following FDA approval of Interstim® for fecal incontinence in 2011, CRS have dramatically increased the number of cases they perform. Neither surgical specialty nor FPMRS fellowship training appear to affect revision or removal rates in the short term.

Funding

none