title: Resource implications of running a sacral neuromodulation service: a 10-year experience.
abstract: OBJECTIVE
  In this study we reviewed our 10-year experience of the medium- to long-term success of sacral nerve stimulation (SNS) for faecal incontinence, with particular reference to the resource implications of running such a service.
  
  
  METHODS
  All patients treated with permanent SNS implants for faecal incontinence from 2001 to 2012 were identified from a prospective database. The patients underwent follow up at 3 and 6 months, with annual review thereafter. They were divided into four groups: group 1, patients optimized after two reviews; group 2, patients optimized after further review; group 3, patients who failed to reach a satisfactory state; and group 4, patients who had a good initial result with subsequent failure.
  
  
  RESULTS
  Eighty-five patients underwent permanent SNS with a median follow up of 24 (range: 3-108) months. Group 1 included 30 (35%) patients; group 2 included 27 (32%) patients [median of two (range: 2-6) additional visits]; group 3 included 18 (21%) patients [median of six (range: 3-10) additional visits]; and group 4 included 10 (12%) patients [median interval to failure was 54 (range: 24-84) months]. Twenty-seven per cent of our patients had an unsatisfactory outcome and the cost of follow up for these patients was £36,854 (48.7% of the total follow-up costs).
  
  
  CONCLUSIONS
  The study highlights the significant resource implications of running an SNS service with a large proportion of patients requiring prolonged review, with more than one-quarter having an unsatisfactory outcome at a substantial cost.
authors.affiliation: Colorectal Surgical Unit, Northern General Hospital, Sheffield, UK.
authors.forename: C M
authors.initials: CM
authors.lastname: McMullin
authors.forename: A M
authors.initials: AM
authors.lastname: Jadav
authors.forename: C
authors.initials: C
authors.lastname: Hanwell
authors.forename: S R
authors.initials: SR
authors.lastname: Brown
mesh_terms: D016208:Databases, Factual; D004599:Electric Stimulation Therapy / Q000191:economics* / Q000295:instrumentation / Q000379:methods; D005242:Fecal Incontinence / Q000191:economics / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D058542:Implantable Neurostimulators / Q000191:economics*; D008160:Lumbosacral Plexus; D008297:Male; D011788:Quality of Life; D016896:Treatment Outcome; D006113:United Kingdom
keywords: Constipation; faecal incontinence; sacral nerve stimulation