213 A Population-based Analysis of Predictors to Penile Surgical Intervention among Inpatients with Acute Priapism
Authors: Ha A , Wallace B , Han D , Miles C , Raup V , Badalato G , Alukal J 
Published: April 2022

ABSTRACT

Introduction
In cases of priapism not amenable to conservative treatment, penile surgical interventions (PSI) such as surgical shunts and inflatable penile prosthesis are often indicated. While risk factors predisposing patients to priapism have been well-established, predictors specific to penile surgical intervention are less well-known and restricted and largely limited to retrospective, single institution studies.

Objective
To identify predictors associated with penile surgical intervention for patients admitted with acute priapism. The secondary objective was to assess the association of PSI with inpatient outcomes such as length of hospital stay and total hospital charges.

Methods
Using the National Inpatient Sample (2010-2015), a cross-sectional descriptive analysis of inpatients with acute priapism was performed and stratified by the presence of any PSI. Previously identified risk factors for priapism were also captured based on biological plausibility and evidence from the literature. Given the paucity of known risk factors to PSI, backwards elimination Akaike Information Criterion was used to construct a survey-weighted multivariable logistic model. Additional survey-weighted negative binomial regression and generalized linear models with logarithmic transformation were utilized to compare association of PSI to length of hospital stay (LOS) and total hospital charges, respectively.

Results
Among a weighted total of 14,529 hospitalizations with a diagnosis of acute priapism, 4,953 (34.1%) underwent PSI. Compared with patients with Medicare, those with Medicaid (OR: 1.47; p=0.003), private insurance (OR: 1.87; p&lt;0.001), and other insurance (OR: 2.70; p&lt;0.001) were at increased odds of undergoing surgical intervention (Figure 1). Similarly, those with a history of substance abuse (OR: 2.04; p&lt;0.001) and ≥3 Elixhauser comorbidities (OR: 1.65; p=0.020) were at increased odds of PSI. Conversely, Black patients (OR: 0.75; p=0.039), sickle cell disease (OR: 0.28; p&lt;0.001), alcohol abuse (OR: 0.48; p&lt;0.001), neurologic diseases (OR: 0.46; p&lt;0.001), solid (OR: 0.16; p&lt;0.001) and hematologic (OR: 0.55; p = 0.012) malignancies, and patients at teaching hospitals (OR: 0.79; p=0.019) were less likely to undergo PSI. Surgical interventions coincided with shorter median hospital length of stay (adjusted Incidence Rate Ratio (IRR):0.62; p&lt;0.001) and lower ratio of the mean hospital charges (adjusted Ratio: 0.49; p &lt;0.001).

Conclusions
Approximately one-third of patients admitted with priapism undergo surgical intervention. Numerous patient and facility-level risk factors have been associated with undergoing PSI, particularly in those with a history of substance abuse. Moreover, patients undergoing PSI were associated with shorter hospital stays and lower hospital charges. Future research exploring which patients may benefit most from surgical intervention would not only curb delays in management, but also potentially reduce healthcare charges.

Disclosure
No