Patterns of Sacral Nerve Modulation Adoption: Impact of State Licensure, Region, and Urbanicity.
Large metropolitan residence linked to significantly reduced sacral nerve modulation use for fecal incontinence.
Patterns of Sacral Nerve Modulation Adoption: Impact of State Licensure, Region, and Urbanicity.
Sacral nerve modulation (sacral nerve modulation) is an effective therapy for fecal incontinence (fecal incontinence), but its national utilization and access remain poorly understood.
Were stratified by state fluoroscopy licensing policies, census region, metropolitan residence, and age.
sacral nerve stimulation less common for patients living in big cities
Among 62,167 patients, sacral nerve modulation was placed in 4.1%, while 1.1% underwent ileostomy/colostomy.
Compared to the West, sacral nerve modulation use was significantly higher in only the South (subdistribution hazard ratio: 1.52, 95% CI: 1.21-1.90; P < 0.001).
Fluoroscopy exam requirements, mandated only in California, did not significantly impact patient likelihood to undergo sacral nerve modulation compared to other states without requirements (subdistribution hazard ratio: 0.77, 95% CI: 0.53-1.12; P = 0.16).
Sacral nerve modulation is underutilized in the United States, with access significantly influenced by geography.
Fluoroscopy examination mandates, regional differences in training density, and structural barriers in metropolitan and western areas may limit sacral nerve modulation adoption.
Policy standardization and expanded training opportunities may help improve equitable access.