(UroToday.com) In a podium presentation at the 2022 American Urologic Association Annual Meeting held in New Orleans and virtually, Dr. Walia examined the health and economic implications of concurrent versus stages testicular implant placement for patients undergoing radical orchiectomy for testis cancer. Discussion of placement of a testicular prosthesis is recommended in American Urological Association guidelines, though utilization is relatively low. The authors, therefore, assessed outcomes and care utilization between the concurrent implant (CI) and staged implant (SI) insertion after radical orchiectomy.
To do so, they used to MarketScan Commercial claims database from 2008 to 2017 to identify men 18 years and older who underwent radical orchiectomy for testicular tumors. Patients were then divided into three groups: orchiectomy with no implant, CI, or SI (any time post-orchiectomy). The authors then examined 90-day rates of reoperation, readmission, emergency department (ED) presentation, and outpatient visits.
Overall, the author identified 8803 men who underwent radical orchiectomy in the dataset. The vast majority (8564) did not have a prosthesis placed while 190 had one placed concurrently and 49 had one placed in a staged fashion. There were no differences in age, Charlson comorbidity index, benefit plan, additional cancer treatment, or metastasis between these groups.
The median perioperative cost at orchiectomy (+/- implant) differed between the groups with lower costs seen in those who had no implant ($5682, 3648-8554) compared to those who had a concurrent ($7823, 5403-10973) or staged implant ($5380, 4130-10521) (p<0.001). When considering the costs of the second operation for insertion of a prosthesis in the staged implant group, overall median perioperative costs rose to $8180 (4920-14591) for a total cost (orchiectomy + implant) of $13560 (5380 + 8180). Stratified by additional cancer treatment (chemotherapy, radiation, retroperitoneal surgery) total postoperative costs follow a similar pattern.
In the 90-days following surgery, patients undergoing concurrent prosthesis implant were more likely to have follow-up (OR 2.48, p=0.006) with more visits (OR 1.54, p=0.030) compared to the stage prothesis group post-implantation, but had similar follow-up (OR 1.93, p=0.065) and less visits (OR 1.29, p=0.025) compared to the stage prosthesis patients’ post-orchiectomy period. No difference in cost or rate of ED visits, readmission, or reoperation was identified.
Overall, prosthesis explanation rates were 4.7% (9) for patients undergoing concurrent prosthesis placement and 14.3% (7) for those undergoing staged prosthesis placement (p=0.04) with a median time to explant of 166 (135-210) and 40 (9.5-141.5) days, respectively (p=0.06). In these patients, the median cost of removal was $2060 (IQR 967-2880).
The authors, therefore, conclude that concurrent prosthesis placement, in the small proportion of patients who opt for a prosthesis, is associated with less total perioperative cost, lower explant rate, and similar postoperative utilization compared to a staged approach.
Presented by: Arman Walia, MD, Resident Physician, UC San Diego
Written by: Christopher J.D. Wallis, University of Toronto, Twitter: @WallisCJD during the 2022 American Urological Association (AUA) Annual Meeting, New Orleans, LA, Fri, May 13 – Mon, May 16, 2022.