AUA AQUA Registry as a Potential Platform for a National Hypospadias Quality Outcomes Registry
Melise A. Keays, MD MSc1, Chris J. Long, MD2, Erin McNamara, MD MPH1, Caleb Nelson, MD MPH1, Carlos R. Estrada, MD MBA1, Raymond Fang, MSC, MASC3.
1Boston Children's Hospital, Boston, MA, USA, 2Children's Hospital of Philadelphia, Philadelphia, PA, USA, 3American Urological Association, Linthicum, MD, USA.
BACKGROUND: The AUA AQUA Quality Registry (AQUA) was established in 2014 and has over 10 million patients with urologic conditions collected from 2013 to 2022. Practices participating in AQUA provide quality feedback regarding their practices through electronic data extraction and obtain quality reporting back from the AQUA. To date, no pediatric conditions have been evaluated in the AQUA Registry.
Objective: To evaluate the current number of pediatric patients with hypospadias in the AQUA database and to evaluate feasibility of extracting simple hypospadias quality data that could be included in a hypospadias quality registry.Methods: The AQUA database was queried for patients with a 1st time diagnosis of hypospadias from 2013-2022. Hypospadias diagnosis codes (ICD9=756.61/ICD10=Q54.0, Q54.1, Q54.2, Q54.3, Q54.4, Q54.8 and Q54.9), as well as hypospadias CPT surgery codes were searched ( One stage Distal Repair (54322, 54324, 54326, 54328), Perineal / Proximal Penile/Penoscrotal (54332, 54336), 2nd stage (54308, 54312), complication repair (54340, 54344, 54348, 54352, 54316, 54318). Patients with isolated chordee and no hypospadias codes (54300, 54304) were excluded. We report the incidence of hypospadias diagnosis by age, race and ethnicity. AUA Census data was linked to identify sub-specialty of urologist performing the surgery and time from 1st reported diagnosis to surgery.Results: There were 14,723 patients with a diagnosis of hypospadias identified from 2013-2022. Of these, 7660 (52%) were adults over 19 yrs [12.1% were 19-40yrs (12.1%), 41-64 (19.5%), > 65yrs (20.5%)]. Children in the sample were < 1yr (21%), 1-5yrs (18.9%) and 6-18yrs (8%). Race was white (54%), black (6.8%), Asian (1.8%), other races (1.4%) and unknown in 35.7%. Ethnic status was non-Hispanic/Latino (62.2%), Hispanic/Latino (6.6%) and unknown in 31.2%. The first recorded surgery was a distal repair in 1152 (87%) while 123 (10%) underwent a proximal repair and 24 (1.9%) were coded as complications. 104 patients (8%) were found to have more than 1 hypospadias repair during their time in the AQUA registry, though it was unclear if this was planned or not. Of these, 57 were distal hypospadias codes, 21 proximal repairs, 16 second stage repair and 10 complication codes. Reported sub-specialty of urologist was known in 61% of surgeries performed. Primary repairs were performed by pediatric urologists (88.6%), general urologists (9.4%) and male GU Recon (0.4%) and other urology areas in 1.7%. Secondary surgeries were mostly done by pediatric urologists 96.2%, 2.6% general and 1.3% other specialties.Conclusions: Analysis of the AUA AQUA Registry reveals a nationally representative hypospadias cohort and one of the largest populations of adults with hypospadias. This demonstrates the potential to extract hypospadias diagnosis codes, hypospadias surgical codes and ability to differentiate distal vs proximal repairs and sub-subspecialty area of providers performing the surgery by linking to AUA Census. Through ongoing work to extract and incorporate standardized quality measures, the AQUA registry can serve as a robust platform for a national quality hypospadias registry.
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