title: Outcomes of Sacral Neuromodulation in a Privately Insured Population.
abstract: OBJECTIVE
  In this study, we analyzed claims data from the Ingenix data base to analyze outcomes of sacral neuromodulation with respect to both provider and patient factors.
  
  
  METHODS
  We used the Ingenix (I3) data base to determine demographic, diagnosis, and procedure success information for years 2002-2007 for privately insured patients. Demographic information was obtained, as were the diagnoses given and procedures performed, based on ICD-9 diagnosis codes and Current Procedural Terminology procedure codes. Multivariate analysis was performed to identify specific predictors of success, as measured by progression to implantation of a pulse generator.
  
  
  RESULTS
  Overall success, as defined by battery placement, was 49.1%. Fifty-one percent of staged procedures were followed by battery placement compared with 24.1% of percutaneous cases (p < 0.0001). Among the patient variables analyzed, women were more likely than men to progress to battery placement. After Stage I testing, patients treated by urologists were overall more likely than gynecologists to proceed to battery placement (I3: 54% vs. 47%, p < 0.0001). Unlike previous findings in other claims-based data sets, we did not observe a provider-volume relationship in the i3 data set.
  
  
  CONCLUSIONS
  Success of sacral neuromodulation, as defined by proceeding to battery placement, was much better after formal staged procedures, which leads us to question the utility of percutaneous techniques. Outcomes were also better among female patients and among those treated by a urologist. Specialty differences will likely diminish over time as more gynecologists adopt sacral neuromodulation.
authors.affiliation: Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Angerj@cshs.org.
authors.forename: Jennifer T
authors.initials: JT
authors.lastname: Anger
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Anne P
authors.initials: AP
authors.lastname: Cameron
authors.affiliation: RAND Corporation, Santa Monica, CA, USA.
authors.forename: Rodger
authors.initials: R
authors.lastname: Madison
authors.affiliation: UCLA Department of Urology, Los Angeles, CA, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Saigal
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: J Quentin
authors.initials: JQ
authors.lastname: Clemens
mesh_terms: D000328:Adult; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012447:Sacrum / Q000502:physiology*; D016896:Treatment Outcome; D014555:Urination Disorders / Q000628:therapy*; D055815:Young Adult
keywords:  urology; Claims data; gynecology; implantable neurostimulators; medical specialty; provider volume