Transitioning penile prosthesis implantation from inpatient to ambulatory settings in Spain
Challenges in healthcare systems across Europe
Healthcare systems worldwide are under pressure due to ageing populations, rising budget constraints, staff shortages and uneven resource distribution.
These challenges have led to fragmented care pathways and inefficiencies across Europe, creating backlogs in non-urgent procedures and further increasing waiting lists that never fully recovered after the COVID-19 pandemic (1).
As demand rises and budgets tighten, value-based healthcare approaches could offer viable alternatives to restore patient-centric solutions while reducing costs and inefficiencies for hospitals.
Ambulatory surgery for instance, which enables patients to be discharged the same day without requiring hospital admission, is a proven way to optimise resources while improving patient care.
It reduces costs, increases hospital capacity, and can shorten wait times for non-urgent procedures. However, the adoption of ambulatory surgeries varies across countries and therapy areas.
The Spanish experience with Penile Prosthesis Implantation (PPI)—a treatment for erectile dysfunction (2) when first- and second-line therapies fail (3)—offers a compelling case study in how a more patient-centric and cost-centric care pathway could meet the evolving needs of patients and healthcare providers.
Delayed urology treatments in Spain
In Spain elective procedures have been deprioritised due to staff shortages and the decentralised nature of the healthcare system (4).
This has led to a substantial increase of patients waiting for urology treatments: from 56,000 patients in 2021 to 75,000 in 2024 (5), with an average wait time of 129 days (6).
Ambulatory surgeries represent less than half (47 per cent in 2023) of all major surgical activity in Spain. For penile prosthesis implantations, that figure drops to less than one in five (17 per cent) (7).
To help close this gap, a broad scientific committee in Spain recently issued a consensus document (8), a structured national framework to implement PPI as an ambulatory surgery for better patient outcomes and resource optimisation, building on previous clinical and economic evidence (9,10) .
The committee is composed of six scientific societies (11) as well as industry and multidisciplinary teams that include urologists, anaesthesiologists, surgeons, nurses and healthcare quality experts.
“Joining forces with the healthcare community is central to our mission to advance science for life, as only together can we better tackle complex health challenges and ensure better, more patient-centric solutions for all,” said Miguel Aragon, vice president of Urology in Europe, Middle East and Africa at Boston Scientific.
“We share with the scientific community the responsibility to enhance patient outcomes.”
A national framework to transition PPI to ambulatory surgery
Traditionally, PPI in Spain has been performed in inpatient settings, requiring patients to stay at least one night in hospital for monitoring and drug administration.
However, a systematic literature review conducted in 2021 (12) and a subsequent cost-consequence analysis (13) both demonstrated that PPI performed in an ambulatory setting offers comparable safety, patient satisfaction and pain management, while significantly lowering costs for hospitals.
PPI performed in the ambulatory setting can save €962 per surgery, with potential annual savings of €410,000 for the Spanish national health system, if 70 per cent of procedures were to be performed using this model.
Building on both clinical and economic evidence, the consensus document issued by the scientific committee details key recommendations around how to streamline care pathways at each phase of the procedure, criteria for patient selection and indicators for quality of care.
“This new paradigm allows us to confidently move PPI surgery to the ambulatory setting, giving PPI patients the opportunity to go home on the same day and releasing hospital beds for other patients with complex recoveries,” said Dr Josep Torremadé Barreda, urologist at the University Hospital Clinic of Barcelona, Spain.
“This may help ensure patient safety and complication risks are preserved along with increased patient satisfaction.”
The transition to ambulatory surgery for PPI is evolving significantly in Spain and could over time offer valuable insights for other therapies and countries who are striving for better patient outcomes while driving financial sustainability for their national healthcare system.
References:
1. https://www.who.int/teams/health-financing-and-economics/global-spending-on-health-2024?
2. Erectile dysfunction affects in Spain about 29 per cent of men aged 40 to 49 in Spain, 50 per cent of those aged 50 to 59, and 74 per cent of men aged 60 to 69. Although it is not life-threatening, untreated ED can severely impact mental health, relationships, overall well-being and societal productivity
3. Mayo Clinic. (2021). Erectile dysfunction: Treatments and drugs. https://www.mayoclinic.org/diseases-conditions/erectiledysfunction/diagnosis-treatment/drc-20355782
4. https://eurohealthobservatory.who.int/publications/i/spain-health-system-review-2024?
5. https://www.sanidad.gob.es/estadEstudios/estadisticas/inforRecopilaciones/listaEspera.htm
6. https://www.mscbs.gob.es/estadEstudios/portada/docs/KEY_DATA_SNHS_ENG_07_2024.pdf
7. A. Hidalgo Grau. Cirugía Mayor Ambulatoria en España. ¿Dónde estamos?. 2021 https://www.asecma.org/Documentos/Articulos/0C_editorial.pdf
8. Óscar Gorría, Matilde Zaballos, María Presa, Luis A. Hidalgo, Jessica M. Lorenzo, Juan I. Martínez-salamanca, Rosario Merino, Ignacio Moncada, Esperanza Torres, Miguel A. Casado, Josep Torremadé. The process map of penile prosthesis implantation in outpatient surgery in Spain: a consensus document Revista Internacional de Andrología. 2024. 22(4);1-9. https://www.intandro.com/articles/10.22514/j.androl.2024.024
9. Systematic literature review https://gateway.zscloud.net/auT origurl=https%3A%2F%2Fwww%2esciencedirect%2ecom%2fscience%2farticle%2fabs%2fpii%2fS2173578622000944%3fvia%253Dihub&_ordtok=Z0k3WVRPLK7sMMNTDFSn1JJ6ZF
10. Cost- consequence analysis https://doi.org/10.1080/20479700.2022.2163336
11. AEEQ Spanish Association of Surgical Nurses; AEU Spanish Association of Urology; ASECMA Spanish Association of Major Ambulatory Surgery; ASESA Spanish Association of Andrology, Sexual and Reproductive Medicine; SECA Spanish Society for Quality of Care; SEDAR Spanish Society of Anesthesiology, Resuscitation and Pain Therapy and Pain Therapeutics
12. See ref. 9
13. See ref. 10
