Mp39-20 preoperative Hemoglobin A1c Optimization Prior to Penile Prosthesis Surgery Results in Sustained Long-Term Glucose Control in Diabetic Men

Abstract

1000 beneficiaries accounting for age and race. Utilization rates were examined nationally and by hospital referral region (HRR).RESULTS: The national adjusted rate of penile prosthesis utilization significantly declined from 5.41 per 1000 beneficiaries in 2006 to 3.74 per 1000 beneficiaries in 2014. The number of beneficiaries diagnosed with ED significantly outpaced the number undergoing surgery. Significant regional variation was observed in penile prosthesis utilization over the study period; as high as a 27-fold difference in 2009 (1.7/1000 in Kansas City, MO to 45.4/1000 in Miami, FL) and 12-fold difference more recently in 2014 (1.9/1000 in Norfolk, VA to 24.2/ 1000 in Miami, FL, See Figure 1). Looking at the year 2014, 1,083,176 beneficiaries carried a diagnosis of ED, while only 4,050 underwent surgery. In 2014, over 65% of HRRs performed zero or < 11 penile prosthesis surgeries and were censored from the analysis.CONCLUSIONS: Significant regional variation exists in the utilization of penile prostheses among Medicare beneficiaries in the U.S.; up to a 27-fold difference was observed over the study period. This variance may be explained by a combination of demand, urologist availability, and patient-specific factors. In addition, over twothirds of U.S. hospital referral regions performed few to zero implants per year. Penile prosthesis placement for the treatment of ED in Medicare beneficiaries is likely dependent on where these patients seek urologic care.