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

Abstract

Introduction: Across all specialties, economic pressure is driving increased utilization of outpatient surgery when feasible. Aims: Our 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. Methods: We analyzed data from National Inpatient Sample. Patients in NIS who underwent PP insertion between 2000 and 2010 were included. Main Outcome Measures: Our main outcomes were the number of inpatient PP procedures, type of prosthesis, patient demographics, comorbidities, hospital characteristics, and immediate perioperative complications. Results: There 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. Conclusions: The 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.