(542) Socioeconomic Status is Not Associated with Complications or Patient Satisfaction Following Inflatable Penile Prosthesis Surgery
Authors: Bhalla R , Gambrah H , Cabo J , Koch G , Marvi T , Zwaschka T A , Watkins E , Kaufman M , Milam D , Johnsen N 
Published: May 2023

Abstract

Introduction
Prior studies have demonstrated that patient socioeconomic background and neighborhood status are associated with health care outcomes. Understanding how a patient’s environment and local community status affect clinical outcomes can vastly impact surgical care, patient education and counseling, as well as surgical outcomes. The Area Deprivation Index (ADI), is a validated measurement evaluating the differences in socioeconomic status between various neighborhoods both on a state and national level. ADI incorporates a composite score of patient income, education level, employment status, and housing quality. No prior studies have looked at how a patient’s socioeconomic status and geographic residence affect postoperative outcomes and patient satisfaction following implantation of inflatable penile prosthesis (IPP).

Objective
To understand how a patient’s socioeconomic status as measured by the ADI affects overall surgical outcomes and patient satisfaction following IPP placement.

Methods
Men that underwent a new IPP placement between 6/1/13 and 3/31/22 were included in the study. Using the Neighborhood Atlas National® (Madison, WI), national ADI percentiles (1-100) were calculated for each patient using their home address at the time of surgery. Higher ADIs represent a more disadvantaged socioeconomic status while lower ADIs represent a more advantaged socioeconomic status. Complications were defined as mechanical failure, urethral erosion, infection, intractable pain, or other (ex. hematoma, herniated reservoir, pump revision). A patient satisfaction phone questionnaire was administered measuring overall satisfaction (Likert scale). In order to reduce recall bias and allow for adequate follow-up, the phone questionnaire was limited to men who underwent IPP placement between the 2016-2020. Multivariable logistic regression and multivariable ordinal logistic regression were used to identify the association between ADI and surgical complications and patient satisfaction, respectively.

Results
A total of 430 men who underwent IPP implantation from 2013 to 2022 were identified and data were retrospectively collected. The final cohort consisted of 83% (n=355) Caucasian men with the median age of 65 (IQR 58-69). The overall complication rate was 11.2% (n=48). Of the 48 total complications, 22 (5.1%) required surgical intervention (mechanical problem n=7, urethral erosion n=1, infection n=9, pain n=1, other n=4). The median national ADI for patients with a complication was 57 (IQR 33-72) compared to 60 (IQR 42-76) in those patients without a complication (p=0.32). A total of 163 men completed the satisfaction phone questionnaire and 70% (n=114) of men stated that they were either very satisfied or satisfied with their IPP. The median ADI for patients who were satisfied was 64 (IQR 43-80) compared to 60 (IQR 42-76) in those patients who were not satisfied (p=0.45). On multivariable analysis, national ADI was not associated with postoperative complications (p=0.57) (Table 1) or with patient satisfaction (p=0.39) (Table 2).

Conclusions
While living in a disadvantaged neighborhood has been associated with poor health outcomes in other areas of medicine, we found no association between a patient’s socioeconomic status and complications or satisfaction following IPP placement. Regardless of a patient’s geographic residence, patients pursuing an IPP can expect comparable outcomes and overall satisfaction rates suggesting that implant consideration should not be influenced by socioeconomic status.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.