30-day adverse event rates following penile prosthesis surgery: an American College of Surgeons National Surgical Quality Improvement Program based evaluation

Abstract

BackgroundCommonly utilized as a third-line therapy for erectile dysfunction (ED) management, the penile prostheses have become a staple treatment for ED refractory to pharmacological interventions. There is however a paucity of data in the literature pertaining to short-term adverse outcomes following penile prosthesis surgery. We thus sought to leverage the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) to evaluate such outcomes within 30 days of surgery in these patients. We hypothesized that such data will lead to a more informed patient-physician consultation.MethodsRelying on the ACS-NSQIP database [2005–2013], patients undergoing penile prosthesis placement were identified utilizing the Current Procedural Terminology (CPT) codes: 54400, 54401, 54405, 54406, 54407, 54408, 54410, 54411, 54416 and 54417. Outcomes assessed included system-wise categorized complications, length-of-stay (LOS), and re-intervention, readmission and 30-day mortality rates. Descriptive statistics were used to analyze available data. Multivariate analysis could not be performed due to small sample size.ResultsOverall, 98 cases of patients who underwent surgery for penile prosthesis placements between the years 2005 and 2013 were reported by the ACS-NSQIP affiliated hospitals. The median age was 65 years (interquartile range, 58–70 years). The overall 30-day complication rate was 11.3% (n=11); 5 of the 11 complications were infectious in etiology, and three were a postoperative blood transfusion event. The median LOS was 1 day. One (1.0%) patient needed to return to the operating room, two patients (2.6%) were readmitted and there was one (1.0%) death within 30 days of the original surgery.ConclusionsSurgery for penile prosthesis appears to be a safe operation despite the routinely advanced age of the patients requiring it. Complications in the immediate postoperative setting are usually infectious. This data can be used in the clinical setting for a more informed patient-physician discussion and patient expectation management.

Distal corporoplasty using an autologous tunica in the management of penile prosthesis pseudo aneurysm

“…Inflatable penile prosthesis placement is an effective and safe treatment option for erectile dysfunction. 1 The 5-year revision rate is low (7%) and revisions are most likely due to infection or mechanical problems with the device. 2 …”

Post-operative antibiotics following placement of a penile prosthesis

“…One of the most devastating complications that can occur following a penile prosthesis is infectious in nature ( 1 , 2 ). Consequently, both proper patient selection and risk management are essential for prosthetic surgeons.…”

“…Consequently, both proper patient selection and risk management are essential for prosthetic surgeons. In a recent paper by Palma-Zamora et al ( 1 ) published in the current issue of Translational Andrology and Urology , the authors present data discussing the short-term (30-day) adverse outcomes that can occur post placement of a penile prosthesis. The authors identified an overall 30-day complication rate of 11%; of which 45% were infectious in etiology ( 1 ).…”

“…In a recent paper by Palma-Zamora et al ( 1 ) published in the current issue of Translational Andrology and Urology , the authors present data discussing the short-term (30-day) adverse outcomes that can occur post placement of a penile prosthesis. The authors identified an overall 30-day complication rate of 11%; of which 45% were infectious in etiology ( 1 ). Diabetes was present in 29% of patients ( 1 ) and although there is some debate regarding the importance of hemoglobin A1c in diabetic patients undergoing prosthesis placement, optimizing peri-operative glucose control for all diabetic patients is essential in reducing the risk of infectious complications ( 3 , 4 ).…”

“…The authors identified an overall 30-day complication rate of 11%; of which 45% were infectious in etiology ( 1 ). Diabetes was present in 29% of patients ( 1 ) and although there is some debate regarding the importance of hemoglobin A1c in diabetic patients undergoing prosthesis placement, optimizing peri-operative glucose control for all diabetic patients is essential in reducing the risk of infectious complications ( 3 , 4 ). Given the significant consequences of infection, a brief discussion regarding post-operative antibiotic usage is warranted.…”