Predictors of Implantable Pulse Generator Placement After Sacral Neuromodulation: Who Does Better?
Predictors of Implantable Pulse Generator Placement After Sacral Neuromodulation: Who Does Better?
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DOI：
10.1111/ner.12109
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发表时间：
2014-06-01
期刊：
影响因子：
2.8
通讯作者：
Clemens, J. Quentin
中科院分区：
文献类型：
--
作者：
Anger, Jennifer T.;Cameron, Anne P.;Clemens, J. Quentin
目的大量的研究已经证明了提供者变量之间的关系，包括外科医生的数量和专业，以及外科手术的结果。在这项研究中，我们分析了医疗保险数据库的索赔数据，分析结果骶神经调节（SNM）方面的供应商和患者factors.Materials和MethodsA 5%的随机抽样的医疗保险受益人从1997年至2007年的数据源。检索的数据包括人口统计学信息、ICD-9诊断代码和CPT程序代码。进行多变量分析，以确定预测的进展植入式脉冲发生器（IPG）implantation. ResultsI阶段测试后，泌尿科医生更有可能比妇科医生进行IPG的位置（中心医疗保险和医疗补助服务：49%与43%，p < 0.0001）。经皮检查后，妇科医生比泌尿科医生更有可能进行电池放置（63% vs.44%，p = 0.005）。在分析的患者变量中，女性比男性更有可能进展到电池放置。接受高容量供应商治疗的患者在正式I期试验后的IPG植入率较高（71% vs. 33%，p < 0.0001）。女性的结果比男性好。进一步的研究可能会更好地定义骶神经调节的结果与排尿功能障碍的特定病因之间的关系。
ObjectivesNumerous studies have documented a relationship between provider variables, including surgeon volume and specialty, and outcomes for surgical procedures. In this study we analyzed claims data from a Medicare database to analyze outcomes of sacral neuromodulation (SNM) with respect to both provider and patient factors.Materials and MethodsA 5% random sample of Medicare beneficiaries from 1997 to 2007 was the data source. Data retrieved included demographic information, ICD-9 diagnosis codes, and CPT procedure codes. Multivariate analysis was performed to identify predictors of progression to implantable pulse generator (IPG) implantation.ResultsAfter stage I testing, urologists were more likely than gynecologists to proceed to IPG placement (Center for Medicare and Medicaid Services: 49% vs. 43%, p < 0.0001). After percutaneous testing, gynecologists were more likely than urologists to proceed to battery placement (63% vs.44%, p = 0.005). Among the patient variables analyzed, women were more likely than men to progress to battery placement. Patients treated by high-volume providers had higher rates of IPG placement after formal stage I trials (71% vs. 33%, p < 0.0001).ConclusionsThe rate of IPG implantation after SNM was greater among high-volume providers. Women had better outcomes than men. Further research may better define the relationship between outcomes of sacral neuromodulation and specific etiology of voiding dysfunction.