title: Impact of Surgeon Case Volume on Reoperation Rates after Inflatable Penile Prosthesis Surgery.
abstract: We investigated the impact of surgeon annual case volume on reoperation rates after inflatable penile prosthesis surgery.
  
  
  
  The New York Statewide Planning and Research Cooperative System database was queried for inflatable penile prosthesis cases from 1995 to 2014. Multivariate proportional hazards regression was performed to estimate the impact of surgeon annual case volume on inflatable penile prosthesis reoperation rates. We stratified our analysis by indication for reoperation to determine if surgeon volume had a similar effect on infectious and noninfectious complications.
  
  
  
  A total of 14,969 men underwent inflatable penile prosthesis insertion. Median followup was 95.1 months (range 0.5 to 226.7) from the time of implant. The rates of overall reoperation, reoperation for infection and reoperation for noninfectious complications were 6.4%, 2.5% and 3.9%, respectively. Implants placed by lower volume implanters were more likely to require reoperation for infection but not for noninfectious complications. Multivariable analysis demonstrated that compared with patients treated by surgeons in the highest quartile of annual case volume (more than 31 cases per year), patients treated by surgeons in the lowest (0 to 2 cases per year), second (3 to 7 cases per year) and third (8 to 31 cases per year) annual case volume quartiles were 2.5 (p <0.001), 2.4 (p <0.001) and 2.1 (p=0.01) times more likely to require reoperation for inflatable penile prosthesis infection, respectively.
  
  
  
  Patients treated by higher volume implanters are less likely to require reoperation after inflatable penile prosthesis insertion than those treated by lower volume surgeons. This trend appears to be driven by associations between surgeon volume and the risk of prosthesis infection.
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, New York. Electronic address: Ico2106@cumc.columbia.edu.
authors.forename: Ifeanyi C
authors.initials: IC
authors.lastname: Onyeji
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, New York.
authors.forename: Wilson
authors.initials: W
authors.lastname: Sui
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, New York.
authors.forename: Mathew J
authors.initials: MJ
authors.lastname: Pagano
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, New York.
authors.forename: Aaron C
authors.initials: AC
authors.lastname: Weinberg
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, New York.
authors.forename: Maxwell B
authors.initials: MB
authors.lastname: James
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, New York.
authors.forename: Marissa C
authors.initials: MC
authors.lastname: Theofanides
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Doron S
authors.initials: DS
authors.lastname: Stember
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, New York.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Anderson
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, New York.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Stahl
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D002983:Clinical Competence; D015331:Cohort Studies; D016208:Databases, Factual; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009519:New York City; D019935:Penile Implantation / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data*; D015917:Penile Prosthesis; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D016526:Workload / Q000706:statistics & numerical data*
keywords: infection; penile prosthesis; postoperative complications