title: Active Polysubstance Abuse Concurrent With Surgery as a Possible Newly Identified Infection Risk Factor in Inflatable Penile Prosthesis Placement Based on a Retrospective Analysis of Health and Socioeconomic Factors.
abstract: BACKGROUND
  Since the introduction of inflatable penile prostheses (IPPs), risk of infection has decreased. However, concurrent substance abuse has not been investigated in prosthetic urology.
  
  
  OBJECTIVE
  To determine whether substance abuse would stand out as a relevant risk factor for infection in patients undergoing IPP implantation.
  
  
  METHODS
  This retrospective study was conducted on charts from the past 12 years at our institution, where a single surgeon completed 602 primary IPP surgeries, with only 12 cases (2%) resulting in postoperative infection. Five of these patients (42%) were actively misusing at least one substance at the time of operation (ie, alcohol, marijuana, cocaine, heroin, other illicit substances, and prescription narcotics). Substance abuse was identified in the medical chart by International Classification of Diseases, Ninth Revision code or by clear documentation by a provider. Multivariate logistic regression analysis was used to estimate the probability of infection as a function of demographic, physical, and treatment variables.
  
  
  METHODS
  Logistic regression analysis was used to determine statistically significant correlations between risk factors and IPP infection.
  
  
  RESULTS
  Polysubstance abuse, poorly controlled blood sugar, and homelessness at the time of procedure positively correlated with postoperative infection. Use of the mummy wrap correlated with decreased infection.
  
  
  CONCLUSIONS
  Active polysubstance abuse, poor glycemic control, and homelessness increase infection risk at IPP implantation. We encourage other implanters to discuss active polysubstance abuse with their patients and to tread cautiously because of the increased risk of infection.
authors.affiliation: Department of Urology, Boston University Medical Center, Boston, MA, USA.
authors.forename: Alejandra
authors.initials: A
authors.lastname: Balen
authors.affiliation: Department of Urology, Louisiana State University-Shreveport, Shreveport, LA, USA. Electronic address: martin.s.gross@gmail.com.
authors.forename: Martin S
authors.initials: MS
authors.lastname: Gross
authors.affiliation: Department of Urology, Boston University Medical Center, Boston, MA, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Phillips
authors.affiliation: Regional Urology, Shreveport, LA, USA.
authors.forename: Gerard D
authors.initials: GD
authors.lastname: Henry
authors.affiliation: Department of Urology, Boston University Medical Center, Boston, MA, USA.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Munarriz
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D007172:Erectile Dysfunction / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D019935:Penile Implantation / Q000009:adverse effects* / Q000379:methods; D015917:Penile Prosthesis / Q000009:adverse effects* / Q000382:microbiology; D010413:Penis / Q000382:microbiology / Q000601:surgery*; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000209:etiology*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000150:complications* / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: Infection; Inflatable Penile Prosthesis; Risk Factor; Substance Abuse