The Decline of Inpatient Penile Prosthesis over the 10-Year Period, 2000–2010

Abstract

IntroductionAcross all specialties, economic pressure is driving increased utilization of outpatient surgery when feasible.AimsOur aims were to analyze national trends of penile prosthesis (PP) surgery and to examine patient and hospital characteristics, and perioperative complications in the inpatient setting.MethodsWe analyzed data from National Inpatient Sample. Patients in NIS who underwent PP insertion between 2000 and 2010 were included.Main Outcome MeasuresOur main outcomes were the number of inpatient PP procedures, type of prosthesis, patient demographics, comorbidities, hospital characteristics, and immediate perioperative complications.ResultsThere was a progressive and dramatic decline by nearly half in the number of both inflatable (IPP) and noninflatable (NIPP) inpatient insertions performed from 2000 to 2010 (P = 0.0001). The overall rate of inpatient complications for PP insertion was 13.5%. Patients with three or more comorbidities were found to have a higher risk of complications than patients with no comorbidities (OR = 1.45, 95% CI = 1.18–1.78) (P = 0.0001). Surgeries performed in high‐volume hospitals (10 or more PP cases per year) were associated with reduced risk of complications (OR = 0.6) (P < 0.0001). There was a dramatic decrease in inpatient setting for PP placement in high‐volume hospitals (32% in 2000 compared with 6% in 2010; P < 0.0001), and when compared with lower volume hospitals. NIPP was more likely performed in younger patients and in community hospitals, and less likely in white patients. Medicaid health insurance was associated with much higher rate of NIPP insertion than other types of insurance.ConclusionsThe number of PP procedures performed in the inpatient setting declined between 2000 and 2010, likely reflecting a shift toward increasing outpatient procedures. Our data also suggest a better outcome for patients having the procedure done at a high‐volume center in terms of inpatient complications. Alwaal A, Harris CR, Hussein AA, Sanford TH, McCulloch CE, Shindel AW, and Breyer BN. The decline of inpatient penile prosthesis over the 10‐year period, 2000–2010. Sex Med 2015;3:280–286.

Safety and Efficacy of Inflatable Penile Prostheses for the Treatment of Erectile Dysfunction: Evidence to Date

“…Due to similar complication rates and lower costs associated with outpatient penile implants, national trends have showed decreasing rates of hospital-based IPP surgeries. [57][58][59][60] Theses studies show that by 2010, more than…”

“…Although there is no consensus, patients who have more comorbidities were more likely to be performed in the inpatient setting given their increased risk for post-operative complications. 59 Segal et al proposed a number of comorbidities that would exclude patients from having their prosthesis performed in an outpatient setting. 61 Patients with comorbidities that increased anesthetic risk such as history of difficult intubation, severe pulmonary disease, BMI>50, OSA, severe cardiac diseases, recent coronary stent placement, precluded them from having their surgery in an outpatient setting.…”

Utilization of penile prosthesis and male incontinence prosthetics in Saudi Arabia

“…[ 3 ] Despite the introduction of PDE5Is and their widespread use, recent reports have demonstrated the increased utilization of penile prosthetics in the United States from 17,540 in 2000 to 22,420 in 2010. [ 4 5 ]…”