Sacral neuromodulation in nursing home residents: Predictors of success and complications in a national cohort of older adults.

There is limited evidence to support the efficacy of sacral neuromodulation (SNM) for older adults with overactive bladder (OAB). This study aims to report outcomes following SNM among nursing home (NH) residents, a vulnerable population with high rates of frailty and comorbidity.

This is a retrospective cohort study of long-stay NH residents who underwent a trial of percutaneous nerve evaluation (PNE) or Stage 1 permanent lead placement (Stage 1) between 2014 and 2016. Residents were identified using the Minimum Data Set linked to Medicare claims. The primary outcome of this study was successful progression from trial to implant. Rates of 1-year device explant/revisions were also investigated.

Trial of SNM was observed in 1089 residents (mean age: 77.9 years). PNE was performed in 66.9% of residents and 33.2% underwent Stage 1. Of Stage 1 procedures, 23.8% were performed with simultaneous device implant (single-stage). Overall, 53.1% of PNEs and 72.4% of Stage 1 progressed to device implant, which was associated with Stage 1 procedure versus PNE (adjusted relative risk [aRR]: 1.34; 95% confidence interval [95% CI]: 1.21-1.49) and female versus male sex (aRR: 1.26; 95% CI: 1.09-1.46). One-year explant/revision was observed in 9.3% of residents (6.3% for PNE, 10.5% for Stage 1, 20.3% single-stage). Single stage procedure versus PNE was significantly associated with device explant/revision (aRR: 3.4; 95% CI: 1.9-6.2).

In this large cohort of NH residents, outcomes following SNM were similar to previous reports of younger healthier cohorts. Surgeons managing older patients with OAB should use caution when selecting patients for single stage SNM procedures.

Neurourology and urodynamics. 2024 Apr 16 [Epub ahead of print]

Leo D Dreyfuss, Farnoosh Nik-Ahd, Lufan Wang, Abigail Shatkin-Margolis, Kenneth Covinsky, W John Boscardin, Anne M Suskind

Department of Urology, Weill Cornell Medical Center, New York, New York, USA., Department of Urology, University of California-San Francisco, San Francisco, California, USA., Department of Obstetrics and Gynecology, University of California, San Francisco, California, USA., Division of Geriatrics, University of California-San Francisco, San Francisco, California, USA., Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California, USA.