title: Understanding the dissemination of sacral neuromodulation.
abstract: OBJECTIVE
  To assess trends in the use of sacral neuromodulation and to measure the magnitude of variation in its use across geographic regions.
  
  
  METHODS
  We used the State Ambulatory Surgery Database (SASD) from 2002 to 2009 from Florida to identify patients implanted with a neuromodulator. Age- and gender-adjusted rates of implantation were calculated by year and by geographic region, defined by the Hospital Service Area. The coefficient of variation was estimated to quantify the magnitude of variation for different time periods.
  
  
  RESULTS
  Adjusted rates of sacral neuromodulation increased significantly from 1.1 per 100,000 population in 2002 to 10.4 per 100,000 population in 2009. The majority of cases were performed for overactive bladder. There was a very large amount of geographic variation in rates of these procedures as evidenced by the high coefficients of variation: 1.67 (2002 and 2003), 1.70 (2004 and 2005), 1.49 (2006 and 2007), and 1.05 (2008 and 2009).
  
  
  CONCLUSIONS
  Rates of sacral neuromodulation have increased dramatically over the past decade. However, these rates of utilization are highly variable across regions, with some regions performing large numbers of these procedures and other regions performing few to no procedures. This range in practice patterns may reflect medical uncertainty surrounding the role of this procedure.
authors.affiliation: 1University of Michigan, Department of Urology.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Suskind
authors.forename: Rodney L
authors.initials: RL
authors.lastname: Dunn
authors.forename: Samuel R
authors.initials: SR
authors.lastname: Kaufman
authors.forename: John O L
authors.initials: JO
authors.lastname: DeLancey
authors.forename: J Quentin
authors.initials: JQ
authors.lastname: Clemens
authors.forename: John T
authors.initials: JT
authors.lastname: Stoffel
authors.forename: Brent K
authors.initials: BK
authors.lastname: Hollenbeck
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004599:Electric Stimulation Therapy / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D012189:Retrospective Studies; D012447:Sacrum / Q000601:surgery; D053201:Urinary Bladder, Overactive / Q000601:surgery / Q000628:therapy*; D055815:Young Adult
keywords: evidence-based medicine/surgery; technology; urology