title: Evaluation of Trends in the Use of InterStim for Fecal Incontinence.
abstract: BACKGROUND
  Fecal incontinence (FI) represents a large source of morbidity and is a challenging clinical problem to manage. InterStim was approved to treat FI in 2011. Little is known about its adoption. We sought to characterize patterns of use of Interstim since Food and Drug Administration approval for FI.
  
  
  METHODS
  The New York State SPARCS database was used to evaluate InterStim use for FI from 2011 to 2014. The primary endpoint was the number of successful implantations of InterStim. Secondary endpoints included device removal, median time to removal of device, 90-day infection rates, and percentage of procedures performed by surgeon specialty and geographic location.
  
  
  RESULTS
  A total of 369 patients with FI underwent "Stage 1" of InterStim from 2011 to 2014. A total of 302 patients underwent "Stage 2," yielding a trial period failure rate of 18.2%. The majority of patients who underwent successful implantation were female (87.7%) and White (78.8%). Twenty-nine patients underwent device removal after a median duration of 147 days. Estimated risk of removal at median follow-up of 2 years was 11.8%. Colorectal surgeons comprised 51.1% of all providers followed by gynecologic (24.4%) and urologic surgeons (17.8%). A total of 71.7% of providers performed <5 procedures, while 3 of the highest volume providers performed 50.7% of all procedures.
  
  
  CONCLUSIONS
  InterStim for FI has been used by a wide variety of providers in New York State although only a few high-volume providers have performed the majority of procedures. White, female patients with Medicare are the most common recipients of InterStim. Further work must be done to develop strategies for improving access to this technology and to determine whether volume relates to outcomes.
authors.affiliation: 1 Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Abelson
authors.affiliation: 2 University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Spiegel
authors.affiliation: 1 Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA.|3 Department of Healthcare Policy and Research, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA.
authors.forename: Heather L
authors.initials: HL
authors.lastname: Yeo
authors.affiliation: 3 Department of Healthcare Policy and Research, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA.
authors.forename: Jialin
authors.initials: J
authors.lastname: Mao
authors.affiliation: 3 Department of Healthcare Policy and Research, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA.
authors.forename: Tianyi
authors.initials: T
authors.lastname: Sun
authors.affiliation: 3 Department of Healthcare Policy and Research, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA.
authors.forename: Art
authors.initials: A
authors.lastname: Sedrakyan
authors.affiliation: 1 Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Milsom
authors.affiliation: 1 Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA.
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Garrett
mesh_terms: D000368:Aged; D020878:Device Removal / Q000706:statistics & numerical data; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000295:instrumentation / Q000706:statistics & numerical data; D004567:Electrodes, Implanted / Q000009:adverse effects*; D005242:Fecal Incontinence / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: colorectal surgery; evidence-based medicine/surgery; image-guided surgery