title: Centers of excellence concept and penile prostheses: an outcome analysis.
abstract: OBJECTIVE
  Outcome analysis has shown that the center of excellence concept, in which all of a specific type of surgery is done by 1 surgeon rather than by multiple surgeons in a group, provides superior outcomes for total joint replacement, radical cancer and heart valve surgery. We compared penile prosthesis implantation outcomes between the center of excellence and multiple surgeon approaches in a large, single specialty urological surgical practice.
  
  
  METHODS
  Between February 2001 and August 2004 a total of 57 penile prostheses were implanted by 10 surgeons at a large urology practice (multiple surgeon group). Between July 2004 and April 2005 a total of 57 penile prostheses were placed by a single surgeon (center of excellence group). Chart review of the 2 patient groups was performed.
  
  
  RESULTS
  The patient groups showed no statistical differences in age, race, cause of impotence or percent with diabetes. The median cylinder length of prostheses placed by the center of excellence surgeon was 2 cm greater than the length of the cylinders placed by the multiple surgeon team (p <0.0001). Excluding cases requiring additional procedures the median placement time was considerably shorter for the center of excellence surgeon than for the multiple surgeon team (34 vs 94 minutes, p <0.0001). There were 8 iatrogenic failures (infection, erosion and poor positioning) requiring surgical removal in the multiple surgeon group but none in the COE group (p <0.05). Although followup for the multiple surgeon team was longer, Kaplan-Meier revision-free survival curves showed significantly longer survival for the center of excellence group (log rank test p = 0.0283).
  
  
  CONCLUSIONS
  The center of excellence concept in penile prosthesis surgery appears to deliver superior surgical outcomes in terms of shorter operative time, longer cylinders and fewer iatrogenic complications.
authors.affiliation: Regional Urology, Shreveport, Louisiana, USA.
authors.forename: Gerard D
authors.initials: GD
authors.lastname: Henry
authors.forename: Neil S
authors.initials: NS
authors.lastname: Kansal
authors.forename: Mark
authors.initials: M
authors.lastname: Callaway
authors.forename: Tobin
authors.initials: T
authors.lastname: Grigsby
authors.forename: Jonathon
authors.initials: J
authors.lastname: Henderson
authors.forename: James
authors.initials: J
authors.lastname: Noble
authors.forename: Thomas
authors.initials: T
authors.lastname: Palmer
authors.forename: Mario A
authors.initials: MA
authors.lastname: Cleves
authors.forename: John K
authors.initials: JK
authors.lastname: Ludlow
authors.forename: Caroline J
authors.initials: CJ
authors.lastname: Simmons
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Mook
mesh_terms: D013502:General Surgery / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D019935:Penile Implantation / Q000592:standards*; D015917:Penile Prosthesis