Unplanned In-Global Clinic Visits, Emergency Department Encounters and Hospital Readmissions following Urological Prosthetic Surgery: Data for Quality Improvement.

INTRODUCTION: Unplanned and potentially avoidable clinic encounters, emergency department visits and readmissions burden the health care system. We identified and characterized unplanned health care utilization during the 90-day global period following urological prosthetic surgery. METHODS: Records of patients undergoing penile prosthesis implantation and/or artificial urinary sphincter placement by a single surgeon between January 2011 and November 2016 were retrospectively reviewed. Unplanned visits to the urology clinic, emergency department and/or hospital for each patient within 90 days of surgery were identified and characterized. RESULTS: Of the 288 surgeries performed during the designated study period 214 were for inflatable penile prosthesis, 59 for artificial urinary sphincter and 15 for a combination. There were 58 unplanned in-global clinic encounters, 13 emergency department visits and 7 hospital readmissions. Unplanned clinic visits were most common for additional teaching, voiding issues and incision concerns, presenting an average of 39 days postoperatively. Emergency department visits were most commonly due to voiding issues and incision concerns, presenting an average of 25 days postoperatively. Hospital readmissions were most common for complications and incision concerns, presenting an average of 23 days postoperatively. CONCLUSIONS: Most unplanned visits during the 90-day global period following urological prosthetic surgery do not require hospital readmission. Improved preoperative counseling, instruction before hospital discharge and/or scheduled phone contact with patients during recovery may reduce unnecessary resource use.

Infection following penile prosthesis placement at an academic training center remains low despite involvement of surgeons-in-training.

Purpose: Primary care providers harbor misconceptions regarding penile prosthetic surgery, largely overestimating the rate of infection. Rates of infection following surgery for primary placement and revision are estimated as 1% to 3% and 10% to 18%, respectively. Our objective was to determine the contemporary incidence of infection following inflatable penile prostheses surgery at an academic training center where surgeons-in-training are routinely involved. Materials and Methods: Review of a prospectively collected single-surgeon database was performed. All cases of inflatable penile prostheses placement from January 2011 through June 2017 were reviewed. Information regarding training level of assistant surgeon(s) was collected, and follow-up data was compiled regarding postoperative infections and need for revision surgery. Results: Three hundred nine cases meeting inclusion criteria were identified. Mean patient age was 64.2 years, and mean follow-up was 28.7 months. Distribution involved 257 (83.2%) for primary placement, 45 (14.6%) for removal/replacement, and 7 (2.3%) in setting of prior device removal. Diabetes was noted in 31.1% of men. Surgeon-in-training involvement was noted in 100% of cases. Infection was confirmed in a patient who had skin breakdown over an area of corporal reconstruction with polytetrafluoroethylene. The overall postoperative infection rate was 0.3%. Conclusions: In this series from an academic training center, infection following penile prosthetic surgery is low, similar to other centers of excellence, even with 100% involvement of surgeons-in-training. This data should be used to better inform primary care providers and members of the general public potentially interested in restoration of sexual function.