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Impact of Surgeon Case Volume on Reoperation Rates after Inflatable Penile Prosthesis Surgery.

Ifeanyi C Onyeji1, Wilson Sui1, Mathew J Pagano1

  • 1Department of Urology, Columbia University Medical Center, New York, New York.

The Journal of Urology
|August 23, 2016
PubMed
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Higher surgeon case volume for inflatable penile prosthesis surgery is linked to lower reoperation rates, particularly for infections. This suggests that surgeon experience significantly impacts patient outcomes and reduces the need for revision surgery.

Area of Science:

  • Urology
  • Surgical Outcomes
  • Health Services Research

Background:

  • Reoperation after inflatable penile prosthesis (IPP) surgery can be associated with significant patient morbidity and healthcare costs.
  • Surgeon experience, often measured by annual case volume, is hypothesized to influence surgical outcomes.

Purpose of the Study:

  • To investigate the association between surgeon annual case volume and reoperation rates following inflatable penile prosthesis insertion.
  • To determine if surgeon volume impacts infectious versus noninfectious complication rates leading to reoperation.

Main Methods:

  • Analysis of the New York Statewide Planning and Research Cooperative System database for IPP cases from 1995 to 2014.
  • Multivariate proportional hazards regression to assess the impact of surgeon annual case volume on reoperation rates.
Keywords:
infectionpenile prosthesispostoperative complications

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  • Stratification of reoperation indications (infection vs. noninfectious complications) to evaluate the influence of surgeon volume.

    • Main Results:

    • A total of 14,969 IPP surgeries were analyzed, with overall reoperation, infection-related, and noninfectious complication-related reoperation rates of 6.4%, 2.5%, and 3.9%, respectively.
    • Lower surgeon annual case volume was significantly associated with increased reoperation rates for infection.
    • Patients treated by surgeons in the lowest quartile of annual case volume (0-2 cases/year) were 2.5 times more likely to require reoperation for infection compared to those treated by high-volume surgeons (>31 cases/year).

    Conclusions:

    • Higher surgeon annual case volume in inflatable penile prosthesis surgery is associated with reduced reoperation rates.
    • The protective effect of higher surgeon volume appears primarily driven by a decreased risk of prosthesis infection.
    • Optimizing surgeon experience and potentially centralizing IPP procedures may improve patient outcomes and reduce revision surgery rates.