TRENDS IN PAEDIATRIC AND ADULT PYELOPLASTY FOLLOWING THE CONSERVATIVE MANAGEMENT OF PAEDIATRIC HYDRONEPHROSIS IN ENGLAND
Naser Al Soudan Al Anazi, MD, Lewis Tylor, MBBS, Wajid Jawaid, MbChB, Phd, FRCS, Navroop Johal, MB Bch FRCS PhD.
Great Ormond Street Hospital, London, United Kingdom.
Background Since the early 1990s, there has been a shift in the management of paediatric hydronephrosis from surgical management to a more conservative approach. However, has this resulted in a secondary increase in adult pyeloplasty rate? We analysed a national prospectively maintained database, Hospital Episode Statistics (HES), to determine trends in pyeloplasty over the last two decades. Methods HES data on patients undergoing pyeloplasty using ICD-10 codes as the primary procedure from 2000/2001 to 2018/2019 was analysed to determine the proportion of pyeloplasties performed on the paediatric population, defined by HES as less than 14 years and then compared with the adult population trends. Results Twenty-one thousand three hundred fifty-one patients underwent a pyeloplasty as a primary procedure during the study period, with an increase from 1056 (366 [35%] paediatric) in 2000/2001 to 1203 (457 [38%] paediatric) in 2018/2019. The mean proportion of pyeloplasties performed on children was 36%, with a non-significant decreasing trend with time, while the mean proportion of pyeloplasties performed on adults was 64%, with a non-significant increase trend with time. In comparison between paediatric patients who underwent pyeloplasty in 2000/2001 to the group in the conservative arm for 14 years with expected interventions in 2014/2015, the mean proportion of pyeloplasty remained steady, 2000-2001 (paediatric 35% / Adult 65%) and 2014/2015 (paediatric 34% / Adult 66%) respectively. Conclusions HES data shows steady paediatric pyeloplasty rates compared with adult pyeloplasties, suggesting conservative management in the paediatric population does not result in a subsequent increase in the intervention rate in adults. Improved and more detailing reporting on a regional/national level will further help evaluate the dataset in the context of the limitations of HES reporting.
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