Postoperative complications of hypospadias surgery: Findings from Pediatric NSQIP Database
David Jiang, MD, Nicholas H. Chakiryan, MD, Kyle Gillis, MD, Ann Martinez Acevedo, MPH, Christopher Austin, MD, Casey Seideman, MD.
Oregon Health & Science University, Portland, OR, USA.
BACKGROUND: Hypospadias is one of the most common procedures performed by pediatric urologists. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) is designed to track 30 day outcomes after surgery. There have been no studies to day looking at 30 day complications of hypospadias repair from this database. Our goal is to determine postoperative complications of hypospadias repairs.
METHODS:A retrospective cohort study from 2012 to 2017 was conducted using ACS NSQIP. Pediatric patients undergoing hypospadias surgery were identified by CPT code and compared based on 4 major categories: distal/midshaft hypospadias one stage repair, proximal one stage repair, stage one of a two-stage repair, and stage two of a two-stage repair. Baseline demographics between the four groups and perioperative parameters were compared. A multivariable logistic regression analysis model including type of repair was used to determine associations with complications.
RESULTS: There were 14,542 patients identified in the study population. Overall, 82% underwent distal/midshaft hypospadias repair, 10% underwent proximal one stage repair, 1.2% underwent stage 1 repair and 7% underwent stage 2 repair. Table 1 shows baseline preoperative parameters of the study population. With regards to postoperative parameters and complications, there was an association between infectious complications, return to OR, readmissions and all complications in stage 2 repairs compared to the rest of the group. On multivariable logistic regression analysis (Table 3), stage 1 of two-stage procedures had similar overall complications to distal/midshaft repairs, but proximal one-stage and stage 2 of two-stage procedures was associated with significantly more complications. Age and hematologic disease are also associated with increased complications.
As expected, complications rates are higher in those with proximal hypospadias. In staged hypospadias, second stage repairs have more complications than first stage repairs. All complications, especially of infectious source are the highest in the second stage repairs. Second stage repairs had the highest rate of complications, most of which appear to be infectious in etiology.
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