Association between surgeon procedure volume and reoperation rates for penile prosthesis implantation

Abstract

Background: Prior studies have examined patient-specific predictors of reoperation following penile prosthesis (PP) insertion at the local and regional level, but little is known about patient factors and volume-outcome relationships at the national level.

Aim: To assess the impact of patient characteristics and surgeon volume on reoperation rates following PP placement in a Medicare population.

Methods: We utilized the 100% Medicare Standard Analytical Files to identify men aged ≥65 years who underwent PP implantation between 2018 and 2021. Surgeon volume data were obtained from the Atlas All-Payor Claims dataset, and quartiles were calculated. Multivariable logistic regression was used to evaluate associations between reoperation rates, patient characteristics, and surgeon volume.

Outcomes: The reoperation rate at 1-year post-implantation, the cause of reoperation, and factors associated with a higher reoperation rate.

Results: Among 8343 patients, 2.3% required reoperation at 90 days and 6.3% at 1 year. The most common comorbidities were diabetes (35.2%), cardiovascular disease (23.9%), Peyronie's disease (15.4%), and obesity (11.5%). Surgeon volume quartiles were calculated, with the highest-volume surgeons performing >31 cases annually versus <6 for the lowest quartile. Lower surgeon volume, older patient age, and smoking were associated with higher reoperation rates. Patients treated by top-quartile surgeons had 25%-28% lower odds of reoperation at 1 year [OR 0.72; 95% CI 0.56-0.93; OR 0.75; 95% CI 0.59-0.97].

Clinical implications: While higher surgeon volume was associated with lower reoperation rates, PP surgery remained safe across all volume levels.

Strengths and limitations: Strengths include the use of a nationally representative Medicare dataset and All-Payor volume-outcome analysis. Limitations include accuracy of claims data, inability to fully characterize reoperations, and lack of data for procedures performed in ambulatory surgery centers.

Conclusion: In a nationally representative Medicare cohort, PP reoperation rates were low (6.3%), with mechanical complications accounting for 41% of reoperations (2.6% of the cohort). Higher-volume surgeons had lower reoperation rates, but outcomes remained acceptable across all volume levels, reinforcing the overall safety of the procedure.

Keywords: penile prosthesis; procedure volume; reoperation.