Outcomes of a novel multidisciplinary approach to delivering sacral neuromodulation services away from the operating theatre.

Abstract

At this tertiary referral hospital, sacral neuromodulation (SNM) evaluation procedures for faecal incontinence (FI) were performed by surgeons in theatre, using general or local anaesthetic. Growing referrals and limited theatre access prompted service reform. A clinical scientist multidisciplinary team member completed bespoke training to perform procedures in outpatients using local anaesthetic. This observational study compares outcomes of clinical scientist-led (CSL) and surgeon-led (SL) evaluation procedures, including clinical success and complications. Demographics and clinical data from patients who underwent CSL procedures were retrospectively compared with patients who underwent SL procedures between 2009 and 2023. A clinically successful evaluation phase outcome was defined as >50% less FI episodes. Statistical analysis was performed using SPSS. Two hundred eleven patients underwent SNM evaluation procedures: 32 in the CSL cohort and 179 in the SL cohort. Patients were predominantly female (93.8%). Median age was 57.1 years. Surgeons mostly used local anaesthetic (61.5%). Technical procedure success was comparable (96.9% vs. 95.5%, p = 1.000) as were successful clinical outcomes (67.7% vs. 69.0%, p = 0.956). Clinically unsuccessful and equivocal evaluation phase outcomes were equivalent (29.0% vs. 28.7%, p = 0.956; 3.2% vs. 2.3%, p = 0.956). Evaluation phase complication rates were similar (3.0% vs. 5.8%, p = 1.000). We introduce the first clinical outcomes of protocolised delivery of outpatient PNE procedures for FI by a clinical scientist. Comparing clinical outcomes with the traditional SL approach in theatre, technical and clinical success are maintained. Crucially, this unique service delivery method is safe for patients.