Impact of Post-hospital Syndrome on Penile Prosthesis Outcomes: A Period of Global Health Risk. Journal Article

Authors: Kirshenbaum, EJ; Nelson, M; Hehemann, MC; Kothari, AN; Eguia, E; Farooq, A; Bresler, L; Gupta, G; Delos Santos, G
Article Title: Impact of Post-hospital Syndrome on Penile Prosthesis Outcomes: A Period of Global Health Risk.
Abstract: PURPOSE: Post-hospital syndrome is an acquired, transient period of health vulnerability following an inpatient admission. This study aims to assess the impact of a preoperative hospitalization on outcomes following penile prosthesis surgery and to optimize surgical timing following an inpatient admission. MATERIALS AND METHODS: The Healthcare Cost and Utilization Project State Inpatient and Ambulatory Databases for California (2007-2011) and Florida (2009-2014) were utilized. Patients were identified as having undergone prosthesis placement by ICD-9 and CPT codes. The primary exposure was post-hospital syndrome, defined as any inpatient admission =90 days prior to prosthesis placement. Patients were further categorized by how recently their inpatient hospitalization occurred. The primary outcome was 30 day readmissions. Secondary outcomes included length-of-stay, device complications and postoperative complications. RESULTS: 16,923 patients who underwent penile prosthesis were identified. Of those, 477 (3%) had a PHS exposure =90 days prior to penile prosthesis placement. After risk-adjustment, PHS patients had higher odds of 30 day readmission (OR 3.0 (95% CI 2.2-4.1)), length-of-stay =2 days (OR 1.7 (95% CI 1.3-2.3)) and device complications (OR 1.7 (95% CI 1.2-2.5)). Categorizing patients in 30-day intervals, we demonstrated a linear decrease in risk of 30-day readmissions as interval between PHS exposure and prosthesis surgery increased. CONCLUSIONS: A post-hospital syndrome exposure is a risk-adjusted predictor of 30-day readmissions, prolonged length-of-stay, and device complication. Medical optimization and delaying surgery can help combat the adverse effects associated with a post-hospital syndrome exposure and may improve surgical outcomes.
Journal Title: The Journal of urology
ISSN: 1527-3792; 0022-5347
Publisher: Elsevier Inc  
Date Published: 2018