title: Sickle Cell Disease in Priapism: Disparity in Care?
abstract: OBJECTIVE
  To determine the effect of sickle cell disease (SCD) on hospital resource use among patients admitted for priapism.
  
  
  METHODS
  Using the Nationwide Inpatient Sample, a weighted sample of 12,547 patients was selected with a primary diagnosis of priapism from 2002 to 2011. Baseline differences for patient demographics and hospital characteristics were compared between SCD and non-SCD patients. Multivariate analysis was performed to identify the effect of SCD on length of stay, use of penile operations, blood transfusion, and cost.
  
  
  RESULTS
  The proportion of SCD patients was 21.5%. SCD patients were younger, more often black, more likely to have Medicaid insurance, and treated more frequently in Southern urban teaching hospitals. SCD was a significant predictor of having a blood transfusion (odds ratio [OR], 16.3; P <.001), and an elongated length of stay (OR, 1.42; P <.001). SCD was associated with less penile operations (OR, 0.40; P <.001). When SCD patients did have an operation, it was performed later in the admission (mean, 0.87 vs 0.47 days; P <.001). SCD was not a significant predictor of increased cost (OR, 1.02; P = .869).
  
  
  CONCLUSIONS
  SCD patients represent a demographically distinct subgroup of priapism patients with different patterns of resource use manifested by longer hospital stays and more blood transfusions. Moreover, despite evidence that immediate treatment of priapism results in improved erectile function outcomes, SCD patients had less surgical procedures for alleviation of acute priapism events.
authors.affiliation: James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins School of Medicine, Baltimore, MD. Electronic address: gjoice1@jhmi.edu.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Joice
authors.affiliation: James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Max
authors.initials: M
authors.lastname: Kates
authors.affiliation: James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Nikolai A
authors.initials: NA
authors.lastname: Sopko
authors.affiliation: James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Johanna L
authors.initials: JL
authors.lastname: Hannan
authors.affiliation: James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Trinity J
authors.initials: TJ
authors.lastname: Bivalacqua
mesh_terms: D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000191:economics / Q000453:epidemiology; D054625:Healthcare Disparities / Q000191:economics*; D006801:Humans; D007297:Inpatients; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D010410:Penile Erection; D011317:Priapism / Q000150:complications* / Q000191:economics / Q000503:physiopathology; D014481:United States / Q000453:epidemiology