Introduction
During the early stages of the COVID-19 pandemic, hospitals prioritized the availability of ventilators, anesthesia personnel, hospital beds, and personal protective equipment; consequently, widespread recommendations were made to postpone or cancel all elective procedures [1,2]. Determination of what was considered “elective” in urology was ill-defined, though there was consensus by international and European urologic societies that the “lowest priority” tier of procedures included those for functional and reconstructive urology, urogynecology, infertility, and prosthetic surgery [3,4]. Though these are indicated for benign conditions, the long-term impact of remaining under-treated is unknown. No data in the existing literature describe the effect of prosthetic surgery cancelations on patient outcomes during the COVID-19 pandemic.
Objective
To determine the primary reasons for cancelation of penile prosthetic implantation during the COVID-19 pandemic and to assess subsequent patient outcomes.
Methods
In this retrospective cohort study, all male patients ≥18 years old scheduled for implantation of a penile prosthesis at our institutions during a 2-year span (1/1/20 to 1/1/22) were eligible for inclusion. Data were abstracted from Epic with ICD-10 and CPT codes for erectile dysfunction and penile prostheses, respectively. Information collected about patients included age, ethnicity, marital status, SHIM score, prior penile implant status, prostate cancer history and therapy, initial date of surgery, cardiac/medical clearance status, cancelation status and cause, whether surgery was rescheduled, and if the surgery ultimately occurred. Crude and adjusted associations between factors related to cancellations were assessed using binary logistic regression and summarized as odds ratio (OR) along with 95% confidence intervals (CI). All statistical analyses were performed using SPSS 28.0.1.
Results
Of the 284 patients that met inclusion criteria, 77 (27.1%) had their surgeries canceled; of those, 33 (42.9%) were later rescheduled, with 31 (93.9%) ultimately undergoing the procedure. There was no significant difference in the average age or SHIM score of those who were and were not canceled. Only 9 (11.7%) of the cancelations were ordered by the hospital, with 4 (5.2%) canceled because of the restriction on elective procedures and 4 (5.2%) due to patients testing positive for COVID. 68 (88.3%) of the cancelations were at the behest of patients; 3 (3.9%) elected not to undergo surgery during the pandemic. The remaining 65 (84.4%) canceled for a variety of reasons, including not getting a pre-procedure UA or COVID test. Patients who did not receive cardiac/medical clearance were three times more likely to cancel (OR 3.04; 95% CI = 1.72-5.37; P<0.001). This association remained statistically significant after adjusting for insurance status (OR 2.32; 95% CI = 1.24-4.34; P=0.009).
Conclusions
Our data revealed that most cancelations of penile prosthetic implantations during COVID-19 were patient-instigated, with few cancelations due to COVID-19 infection or reluctance to have surgery during the pandemic. Most cancelations appeared secondary to difficulties with pre-procedure labs/testing, likely to have been an indirect consequence of the COVID-19 pandemic. Severely limited availability of PCP or lab appointments caused patients increased difficulty obtaining the necessary testing before surgery. Nevertheless, many of the canceled patients were able to reschedule, with nearly all ultimately undergoing the procedure.
Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Rigicon, Coloplast, Baxter.
