Sickle Cell Disease in Priapism: Disparity in Care?

OBJECTIVE: To determine the effect of sickle cell disease (SCD) on hospital resource use among patients admitted for priapism. MATERIALS AND METHODS: Using the Nationwide Inpatient Sample, a weighted sample of 12,547 patients was selected with a primary diagnosis of priapism from 2002 to 2011. Baseline differences for patient demographics and hospital characteristics were compared between SCD and non-SCD patients. Multivariate analysis was performed to identify the effect of SCD on length of stay, use of penile operations, blood transfusion, and cost. RESULTS: The proportion of SCD patients was 21.5%. SCD patients were younger, more often black, more likely to have Medicaid insurance, and treated more frequently in Southern urban teaching hospitals. SCD was a significant predictor of having a blood transfusion (odds ratio [OR], 16.3; P <.001), and an elongated length of stay (OR, 1.42; P <.001). SCD was associated with less penile operations (OR, 0.40; P <.001). When SCD patients did have an operation, it was performed later in the admission (mean, 0.87 vs 0.47 days; P <.001). SCD was not a significant predictor of increased cost (OR, 1.02; P = .869). CONCLUSION: SCD patients represent a demographically distinct subgroup of priapism patients with different patterns of resource use manifested by longer hospital stays and more blood transfusions. Moreover, despite evidence that immediate treatment of priapism results in improved erectile function outcomes, SCD patients had less surgical procedures for alleviation of acute priapism events.

Malleable penile prosthesis is a cost-effective treatment for refractory ischemic priapism.

INTRODUCTION: Refractory ischemic priapism (RIP) can be difficult to treat, consuming significant healthcare-related resources. Acute insertion of a malleable penile prosthesis (MPP) has been reported as an effective therapy that treats the priapism and restores sexual function. AIM: We report our 6-year, urban public hospital experience with acute insertion of MPP in patients with RIP. METHODS: We retrospectively reviewed the records of patients receiving MPPs for RIP from 2007 to 2013. Data analyzed included duration of erection, number of emergency room (ER) visits, hospital admissions, days of hospitalization, and postoperative course. Costs were estimated using standard Medicare reimbursement rates. MAIN OUTCOME MEASURE: Healthcare-related costs of treatment of RIP episodes in men presenting to our institution. RESULTS: During the study period, 14 men underwent MPP placement acutely for refractory priapism. Thirteen presented with RIP, and one had stuttering priapism over a 14-day hospitalization. Etiologies included sickle cell anemia (4/13, 29%), medication-induced (3/14, 21%), and idiopathic (7/14, 50%). Average preoperative duration of RIP was 82 hours with considerable consumption of health-care resources (average US $83,818 estimated cost, 4 ER visits [range 1-27], 2 hospital admissions [range 1-5], 1.5 shunt procedures [range 1-3], 5 irrigation and drainage procedures using phenylephrine injection [range 2-20], and 5 hospital admission days [range 2-14]). All patients were discharged within 24 hours of MPP surgery. CONCLUSIONS: The management of RIP is associated with multiple ER visits, prolonged hospital admissions, and significant resource utilization. MPP insertion is efficacious for the immediate resolution of refractory priapism, with potential cost and resource benefits.

Nationwide emergency department visits for priapism in the United States.

INTRODUCTION: The epidemiology of priapism is not well characterized. A small number of studies based on inpatient data or small population samples have estimated the incidence to range from 0.34 to 1.5 cases per 100,000 males. AIM: To estimate the current epidemiology and impact on resource utilization of priapism in the United States (US). MAIN OUTCOME MEASURES: Rate of emergency department encounters for priapism in the US. METHODS: Emergency department (ED) visits for priapism were analyzed using discharge data from the Nationwide Emergency Department Sample (NEDS), Healthcare Cost and Utilization Project (HCUP). Priapism encounters were identified by ICD9 code. Priapism encounters were analyzed for patient and hospital characteristics, associated diagnoses, and hospital charge. Established weighting in the sample was used to calculate nationwide estimates. RESULTS: A total of 8,738 ED encounters for priapism were identified between 2006 and 2009 in the NEDS. This translated to an estimated 39,964 encounters out of a total of 496,195,793 ED visits, or 8.05 per 100,000 ED visits (95% confidence interval [CI] 7.59-8.51). 21.1% of patients had a concurrent diagnosis of sickle cell disease (SCD). 72.1% of all patients were discharged home from the ED, while only 49.6% of patients with SCD were discharged home. A concurrent diagnosis of SCD was associated with an odds ratio (OR) of 3.84 (95% CI 3.65-4.05) for admission to the hospital when controlling for age, region, hospital and payer type. The mean hospital charge was $1,778 per encounter if discharged home and $41,909 per encounter if admitted. The estimated mean total annual charge for priapism was $123,860,432 with 86.8% of charges attributed to inpatient admissions. CONCLUSIONS: Our estimate of the rate of ED visits for priapism was significantly higher than prior estimates with a SCD concurrence rate lower than previously estimated.

Sexual health outcomes improvement in sickle cell disease: a matter of health policy?

INTRODUCTION: Ischemic priapism is a true male sexual dysfunction, consisting of uncontrollable, prolonged, and often painful erections of the penis. A commonly observed outcome, as a result of erectile tissue damage and fibrosis in this setting, is the complete loss of natural erectile ability. Males with sickle cell disease (SCD) are commonly affected. Given the adverse health consequences of this condition coupled with its specific population extent, health policy considerations are warranted. AIM: This article aimed to study circumstances surrounding priapism associated with SCD for the purpose of pushing forward health policy objectives that improve sexual health-related outcomes. METHODS: Medline searches through July 2010 were conducted using the following terms: priapism, sickle cell disease, epidemiology, public health, health economics, and health policy. MAIN OUTCOME MEASURE: Expert opinion was based on review of the medical literature related to this subject matter. RESULTS: The literature search affirmed that SCD-associated priapism threatens sexual health and also exerts a greatly negative impact on the physical and mental health of affected individuals. Various socioeconomic, behavioral, and cultural factors in the SCD population bearing negatively on sexual health outcomes were delineated. Deficiencies in several aspects of medical services for patients with SCD including scientific research funding support, which evoke an element of ethnic healthcare disparities, were further delineated. CONCLUSIONS: SCD-associated priapism is a medical condition of societal health significance, which can and should be addressed through comprehensive healthcare programmatic efforts. These efforts comprise advancement of educational and clinical training programs, support of interdisciplinary healthcare delivery services, diffusion of clinical advances, enactment of guidelines for effective clinical management, and resource allocation for enabling scientific advancements.