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Introduction:
More pediatric patients seem to present to the emergency room for non-urgent matters after urologic procedures compared to adult patients. We compare our 30 day post-operative bounce-back rates and the acuity of the concerns in these populations.
Methods:
All urology consults at our institution are maintained on a prospectively tracked database. We identified all patients who presented to our adult or pediatric emergency department between July 2013 and June 2015 within 30 days of a urologic procedure. We investigated the procedures performed, chief complaint in the ED, diagnosis, and treatment required.
Results:
In our pediatric group, there were 67 visits in 56 patients (19 female, 37 male, mean age 7.4 years), which represents an incidence of 2.5%. Of those, 19% required admission, 10% underwent a procedure, 18% required catheter manipulation/placement, 13% were given a prescription (most commonly for constipation), 6% required local wound care, and 33% were reassured only.
In the adult population, there were 369 visits in 310 patients (111 female, 199 male, mean age 55.4 years) for an incidence of 3.5%. Of those, 42% were admitted, 14% underwent a procedure, 11% required catheter manipulation/placement, 14% were given medication (most commonly antibiotics and narcotics), 4% were given local wound care, and 12% were reassured.
Conclusions:
Compared to adults, pediatric patients are less likely to return to the ED post-operatively (p=0.03), but they are significantly more likely to require only reassurance (p<0.01) while adults are significantly more likely to require hospital admission or a procedure (p<0.01). In both groups, nearly one third of patients required only catheter care or medication. Better anticipation of post-operative medication needs and catheter education could decrease unnecessary ED visits and health care costs.

Pediatric versus Adult Bounce-backs

	Admission or Procedure	Medical Treatment or Catheter Manipulation/Placement	Reassurance Only (No treatment)
All Pediatric Patients	29%	38%	33%
	Admit 19% OR 10%
All Adult Patients	56%	32%	12%
	Admit 42% OR 14%
P value	p < 0.01	p = 0.49	p < 0.01