Society For Pediatric Urology

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Morbidity of minimally invasive versus open pediatric pyeloplasty within thirty days.
Michael Bell, MSc, Gregory Joice, MD, Nikolai Sopko, MD PhD, Kara Choate, MD, Hiten Patel, MD MPH, Matthew Kasprenski, MD, John Gearhart, MD, Heather Di Carlo, MD.
Johns Hopkins University School of Medicine, Baltimore, MD, USA.

BACKGROUND: In children with symptomatic ureteropelvic junction obstruction, pyeloplasty remains the gold standard for surgical correction. The surgical approach for this procedure may be minimally invasive or open. Data on complication outcomes within the thirty-day perioperative period in children undergoing pyeloplasty is limited. Our study characterized patients undergoing pediatric pyeloplasty and explored the overall rates of complications and readmission specifically to determine if there were differences in outcomes following a minimally invasive surgical versus open approach.
METHODS: We utilized the National Surgical Quality Improvement Program (NSQIP) Pediatric database to identify 1,767 patients undergoing pyeloplasty from 2012 to 2016. We identified pediatric patients under 18 years old using the CPT codes commonly used for billing pyeloplasty procedure and characterized the demographics of this patient cohort. We used a multivariable logistic regression using SAS to evaluate for independent predictors for our primary outcomes of any complication and controlled for various factors including age, gender, sex, BMI, race, and ASA group.
RESULTS: Females patients made up 28.5% of this cohort. In terms of race, African-Americans made up 11.1% and Caucasians 71.7% with the remainder classified as Other. Cases performed via minimally invasive surgery (MIS) approach (13.6% of cases) had patients that were on average older age (545 vs. 306 days, p < 0.001) and had longer median operative times (167 vs. 137 minutes, p <0.001). The overall complication rate was 4.5% with infectious complications occurring in 3.5% of cases. The thirty-day readmission rate was 6.2% overall and there were no deaths. Readmission was more common in the MIS group (8.1 vs. 5.9%) but this was not statistically significant on multivariable analysis (OR 1.42, p =0.18). Multivariable analysis did reveal female gender to be associated with an increased risk of infectious complications (OR 1.88, p = 0.018) and readmission (OR 1.60, p = 0.023).
CONCLUSIONS: This study represents the most recent population-based data available on the characteristics of pediatric patients undergoing plyeloplasty. Although our data source cannot be considered a truly randomly selected sample and lacked data on hospital characteristics limiting inter-hospital variation, this study is our best approximation of contemporary clinical practice nationally. This analysis of thirty-day morbidity could allow us to anticipate complications and proactively manage prevention and intervention strategies sparing patients of complication and potentially facilitating cost-savings. This could be expressly important in regard to the gender disparity and infectious complication rate described in this study. Altogether these observations highlight the importance of continued vigilance and monitoring of these children throughout the post-discharge period.

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