Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
J Sex Med. 2019 Sep;16(9):1451-1458. doi: 10.1016/j.jsxm.2019.07.004. Epub 2019 Aug 9.
Penile prosthesis surgery has witnessed a migration from the inpatient to ambulatory surgical care setting. However, little is known about the cost savings afforded by this change in care setting and whether or not these savings come at the expense of worse perioperative outcomes.
The aim of this study was to identify predictors of index penile prosthesis (PP) surgery care setting, and whether ambulatory vs inpatient surgery is associated with comparable perioperative outcomes and costs.
This was a retrospective cohort study using all-payer claims data from the 2014 Healthcare Cost and Utilization Project State Databases from Florida and New York. Patient demographics, regional data, total charges (converted to costs), and 30-day revisit rates were abstracted for all patients undergoing index placement of an inflatable or malleable PP. Multivariable logistic and linear regression adjusted for facility clustering was utilized.
The outcomes were index surgical and 30-day postoperative costs, as well as 30-day revisit rates.
Of the 1,790 patients undergoing an index surgery, 394 (22.0%) received care in the inpatient setting compared to 1,396 (78.0%) in the ambulatory setting. Adjusted index procedural ($9,319.66 vs $ 10,191.35; P < .001) and 30-day acute care costs ($9,461.74 vs $10,159.42; P < .001) were lower in the ambulatory setting. The underinsured experienced lower odds of receiving surgery in the ambulatory setting (Medicaid vs private: odds ratio [OR] 0.19; 95% CI 0.06-0.55; P < .001). There was no difference in risk-adjusted odds of experiencing a 30-day revisit between patients undergoing surgery in the ambulatory vs inpatient settings (OR 1.31; 95% CI 0.78-2.21; P = .3).
Ambulatory PP surgery confers significant cost savings and is associated with comparable perioperative outcomes relative to inpatient-based surgery.
Both clinical and nonclinical factors predict the care setting of index PP surgery. Notably, underinsured patients experienced lower odds of undergoing ambulatory surgery. Ambulatory surgery was less costly with similar 30-day revisit rates relative to inpatient-based care. Berger A, Friedlander DF, Herzog P, et al. Impact of Index Surgical Care Setting on Perioperative Outcomes and Cost Following Penile Prosthesis Surgery. J Sex Med 2019;16:1451-1458.
阴茎假体手术已经从住院治疗转变为门诊手术。然而，对于这种治疗模式的转变所带来的成本节约知之甚少，而且这种节约是否是以手术围术期结果变差为代价的。
本研究的目的是确定索引阴茎假体（PP）手术护理环境的预测因素，以及门诊与住院手术是否与可比的围手术期结果和成本相关联。
这是一项回顾性队列研究，使用了来自佛罗里达州和纽约 2014 年医疗保健成本和利用项目州数据库的所有支付者索赔数据。为所有接受可膨胀或可塑 PP 指数放置的患者提取患者人口统计学、区域数据、总费用（转换为成本）和 30 天复诊率。利用多变量逻辑和线性回归来调整设施聚类。
在 1790 名接受指数手术的患者中，394 名（22.0%）在住院环境中接受治疗，1396 名（78.0%）在门诊环境中接受治疗。调整后的指数手术费用（9319.66 美元比 10191.35 美元；P <.001）和 30 天急性护理费用（9461.74 美元比 10159.42 美元；P <.001）在门诊环境中较低。未参保者在门诊环境中接受手术的可能性较低（医疗补助与私人保险：比值比 [OR] 0.19；95%可信区间 0.06-0.55；P <.001）。在门诊与住院环境下接受手术的患者 30 天内复诊的风险调整比值比（OR）无差异（OR 1.31；95%可信区间 0.78-2.21；P =.3）。
门诊 PP 手术可显著节省成本，并与基于住院的手术相比具有相似的围手术期结果。
临床和非临床因素均预测了指数 PP 手术的护理环境。值得注意的是，未参保患者接受门诊手术的可能性较低。与基于住院的护理相比，门诊手术成本较低，30 天复诊率相似。
