A Nationwide Analysis of Postpenile Prosthesis Infection: Do Hospital and Surgeon Volume Matter?

To evaluate the association between hospital and surgeon procedural volumes of inflatable penile prosthesis implantation and postoperative infection rates, and to examine patient risk factor differences across volume quartiles.

A retrospective cohort study of US males undergoing de novo inflatable penile prosthesis insertion (2016-2022) used the Premier PINC AI Healthcare Database. Patients were categorized by hospital and surgeon procedural volumes. Infection rates, defined by diagnosis and procedure codes, were compared between lowest and highest volume quartiles. Established risk factors for infection (eg, age, smoking, diabetes, HIV, prior pelvic radiation, obesity, concomitant circumcision, Peyronie's disease) were analyzed. Logistic and Cox regressions assessed associations between volume quartiles, infection rates, and risk factors.

Among 18,475 patients, hospital and surgeon data were available for 100% and 70.2%, respectively. Median follow-up was 3years. Infection rates were lower at high-volume hospitals (2.4%) than low-volume hospitals (3.7%; HR 0.64, 95% CI [0.489, 0.834], P=.001). Surgeon volume showed a similar but insignificant trend (2.7% vs 3.2%; HR 0.87, 95% CI [0.644, 1.181], P=.377). Patients at high-volume hospitals and with high-volume surgeons less frequently had risk factors (21.9% vs 25.8%, P<.001; 21.4% vs 25.8%, P<.001). Type 2 diabetes was less common at high-volume hospitals (6.7% vs 9.7%, P<.001) and among high-volume surgeons (7.1% vs 10.2%, P<.001), while circumcision and Peyronie's disease were more prevalent in high-volume settings (P<.001).

High-volume facilities and surgeons were linked to lower infection rates, suggesting targeted interventions could improve outcomes at low-volume sites.