title: The Decline of Inpatient Penile Prosthesis over the 10-Year Period, 2000-2010.
abstract: BACKGROUND
  Across all specialties, economic pressure is driving increased utilization of outpatient surgery when feasible.
  
  
  OBJECTIVE
  Our aims were to analyze national trends of penile prosthesis (PP) surgery and to examine patient and hospital characteristics, and perioperative complications in the inpatient setting.
  
  
  METHODS
  We analyzed data from National Inpatient Sample. Patients in NIS who underwent PP insertion between 2000 and 2010 were included.
  
  
  METHODS
  Our main outcomes were the number of inpatient PP procedures, type of prosthesis, patient demographics, comorbidities, hospital characteristics, and immediate perioperative complications.
  
  
  RESULTS
  There was a progressive and dramatic decline by nearly half in the number of both inflatable (IPP) and noninflatable (NIPP) inpatient insertions performed from 2000 to 2010 (P = 0.0001). The overall rate of inpatient complications for PP insertion was 13.5%. Patients with three or more comorbidities were found to have a higher risk of complications than patients with no comorbidities (OR = 1.45, 95% CI = 1.18-1.78) (P = 0.0001). Surgeries performed in high-volume hospitals (10 or more PP cases per year) were associated with reduced risk of complications (OR = 0.6) (P < 0.0001). There was a dramatic decrease in inpatient setting for PP placement in high-volume hospitals (32% in 2000 compared with 6% in 2010; P < 0.0001), and when compared with lower volume hospitals. NIPP was more likely performed in younger patients and in community hospitals, and less likely in white patients. Medicaid health insurance was associated with much higher rate of NIPP insertion than other types of insurance.
  
  
  CONCLUSIONS
  The number of PP procedures performed in the inpatient setting declined between 2000 and 2010, likely reflecting a shift toward increasing outpatient procedures. Our data also suggest a better outcome for patients having the procedure done at a high-volume center in terms of inpatient complications. Alwaal A, Harris CR, Hussein AA, Sanford TH, McCulloch CE, Shindel AW, and Breyer BN. The decline of inpatient penile prosthesis over the 10-year period, 2000-2010. Sex Med 2015;3:280-286.
authors.affiliation: Department of UrologyUniversity of California San FranciscoSan FranciscoCAUSA; Department of UrologyKing Abdul Aziz UniversityJeddahSaudi Arabia.
authors.forename: Amjad
authors.initials: A
authors.lastname: Alwaal
authors.affiliation: Department of Urology University of California San Francisco San Francisco CA USA.
authors.forename: Catherine R
authors.initials: CR
authors.lastname: Harris
authors.affiliation: Department of Urology University of California San Francisco San Francisco CA USA.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Hussein
authors.affiliation: Department of Urology University of California San Francisco San Francisco CA USA.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Sanford
authors.affiliation: Department of Epidemiology and Biostatistics University of California San Francisco San Francisco CA USA.
authors.forename: Charles E
authors.initials: CE
authors.lastname: McCulloch
authors.affiliation: Department of Urology University of California at Davis Sacramento CA USA.
authors.forename: Alan W
authors.initials: AW
authors.lastname: Shindel
authors.affiliation: Department of Urology University of California San Francisco San Francisco CA USA.
authors.forename: Benjamin N
authors.initials: BN
authors.lastname: Breyer
keywords: Complications; Erectile Dysfunction; Outpatient Surgery; Penile Prosthesis