90-day postoperative care utilization and costs.

Purpose
American Urological Association guidelines recommend testicular prosthesis discussion prior to orchiectomy. Utilization may be low. We compared outcomes and care utilization between concurrent implant (CI) and staged implant (SI) insertion after radical orchiectomy.
Materials & methods
The MarketScan Commercial claims database (2008–2017) was queried for men ages >18 years who underwent radical orchiectomy for testicular mass, stratified as orchiectomy with no implant, CI, or SI. 90-day outcomes included rate of reoperation, readmission, emergency department (ED) presentation, and outpatient visits. Regression models provided rate ratio comparison.
Results
8803 patients (8564 no implant, 190 CI, 49 SI; 2.7% implant rate) were identified with no difference in age, Charlson Comorbidity Index, insurance plan, additional cancer treatment, or metastasis. Median perioperative cost at orchiectomy (+/- implant) for no implant, CI, and SI were $5682 (3648–8554), $7823 (5403–10973), and $5380 (4130–10521), respectively (p<0.001). Median perioperative cost for SI at implantation was $8180 (4920–14591) for a total cost (orchiectomy + implant) of $13650 (5380 + 8180). CI patients were more likely to have follow-up (p = 0.006) with more visits (p = 0.030) compared to the SI group post-implantation but had similar follow-up (p = 0.065) and less visits (p = 0.025) compared to the SI patients’ post-orchiectomy period. Overall explant rates were 4.7% for CI and 14.3% for SI (p = 0.04) with a median time to explant of 166 (IQR: 135–210) and 40 days (IQR: 9.5–141.5; p = 0.06). Median cost of removal was $2060 (IQR: 967–2880).
Conclusions
CI placement has less total perioperative cost, lower explant rate, and similar postoperative utilization to SI.

研究目的：美国泌尿外科学会（American Urological Association, AUA）指南推荐，在睾丸切除术（orchiectomy）前应与患者讨论睾丸假体植入事宜，但目前该操作的临床应用率或偏低。本研究旨在对比根治性睾丸切除术后同期植入（concurrent implant, CI）与分期植入（staged implant, SI）假体的患者结局与医疗资源利用情况。

材料与方法：本研究检索了2008-2017年的MarketScan商业保险索赔数据库，纳入因睾丸肿物行根治性睾丸切除术的18岁以上男性患者，按手术方式分为无假体植入组、同期植入组与分期植入组。以术后90天内的再手术率、再入院率、急诊科（emergency department, ED）就诊率及门诊就诊率作为结局指标，采用回归模型计算率比（rate ratio）进行组间比较。

结果：本研究共纳入8803例患者，其中无假体植入组8564例、同期植入组190例、分期植入组49例，假体植入总使用率为2.7%。三组患者在年龄、查尔森合并症指数（Charlson Comorbidity Index, CCI）、保险类型、额外癌症治疗方案及是否存在转移方面均无显著差异。无假体植入组、同期植入组与分期植入组患者根治性睾丸切除术（联合/不联合假体植入）的围手术期中位费用分别为5682美元（四分位距：3648~8554美元）、7823美元（5403~10973美元）与5380美元（4130~10521美元），组间差异具有统计学意义（p<0.001）。分期植入组患者单独假体植入手术的围手术期中位费用为8180美元（4920~14591美元），其总治疗费用（根治性睾丸切除术+假体植入术）为13650美元（5380+8180）。与分期植入组相比，同期植入组患者在假体植入后的随访率更高（p=0.006），门诊就诊次数更多（p=0.030）；而与分期植入组患者的睾丸切除术后随访周期相比，同期植入组患者的随访率无显著差异（p=0.065），但门诊就诊次数更少（p=0.025）。同期植入组与分期植入组的总体假体取出率分别为4.7%与14.3%（p=0.04），假体取出中位时间分别为166天（四分位距：135~210天）与40天（9.5~141.5天；p=0.06）。假体取出手术的中位费用为2060美元（967~2880美元）。

结论：根治性睾丸切除术后同期植入睾丸假体的患者，其总围手术期费用更低、假体取出率更低，且术后医疗资源利用情况与分期植入组相当。