Increasing Utilization of Outpatient Surgery for Inflatable Penile Prosthesis Placement: Contemporary Data from the National Surgical Quality Improvement Program Database

Abstract

ABSTRACT Introduction The inflatable penile prosthesis (IPP) is the gold-standard surgical treatment for medically refractory erectile dysfunction. Objective The aim of this study is to characterize the differences between inpatient (IP) and outpatient (OP) practice patterns for IPP placement while utilizing the National Surgical Quality Improvement Program (NSQIP) database to identify and compare factors and outcomes associated with each approach. Methods NSQIP database was queried for men undergoing IPP placement between 2009-2019. Patients were classified as either IP (>24 hours) or OP (<24 hours). Baseline demographics, operating time, and complications were compared between the two groups. Multivariate logistic regression evaluated factors associated with discharge timing and 30-day complications. Results A total of 456 patients were identified and classified: 185 as IP and 271 as OP. Statistically significant differences were noted in co-morbidities favoring inpatient surgery between the groups including chronic steroid use, chronic obstructive pulmonary disease, congestive heart failure, acute renal failure, end-stage renal disease, and bleeding disorders. Year of surgery was also significant, with a notable increase in outpatient surgery beginning in 2015 (p<0.001). The 30-day complication rates between both groups differed notably for any complication (20.5 IP, 3.3% OP, p< 0.001), any readmission (9.7% IP, 2.2% OP, p <0.001), intraoperative or post-operative transfusion (8.1% IP, 0% OP, p< 0.001), and sepsis (4.1% IP, 0% OP, p<0.001). Operative time was shorter in the OP group (159.10 minutes IP, 133.50 minutes OP, p <.001). Conclusions IPP placement is increasingly utilized as an OP procedure. OP surgery favors patients with few medical co-morbidities and shorter operative times. Beginning in 2015, trends began to shift toward OP procedures. In the era of increasing hospital costs, a shift toward outpatient prosthetic surgery has increased. Disclosure No