Risk factors for repeat surgical intervention in pediatric nephrolithiasis: A Pediatric Health Information System database study. J Pediatr Urol 2018 Jun;14(3):245.e1-245.e6
Date
03/28/2018Pubmed ID
29580730DOI
10.1016/j.jpurol.2018.02.017Scopus ID
2-s2.0-85044282760 (requires institutional sign-in at Scopus site) 13 CitationsAbstract
INTRODUCTION: Successful surgical therapy for pediatric upper urinary tract calculi (UUTC) minimizes the need for repeat surgical interventions. However, staged procedures, whether planned or unplanned, are sometimes necessary. We assessed predictors of repeat intervention for children with UUTC using a nationwide administrative dataset.
METHODS: Using the Pediatric Health Information System (PHIS) dataset, we assessed children with UUTC undergoing shock wave lithotripsy (SWL) or ureteroscopy (URS) for an index stone from January 2010 to June 2015. Primary outcome was additional treatment for nephrolithiasis within 90 days. Patient and procedural variables were assessed as potential risks for retreatment. Multivariable logistic regression models were used to compare the risk of retreatment adjusting for potential confounding factors.
RESULTS: A total of 2788 patients undergoing URS (2,216, 79.5%) and SWL (572, 20.5%) were identified. SWL, stenting at the index operation without pre-index stenting, chronic comorbidities, renal calculi, and age <5 years were independent risk factors for retreatment. Use of ureteral stenting, most commonly employed in URS, was also a strong predictor of retreatment. Odds for reintervention, adjusted by multivariate modeling, are shown in the Figure.
CONCLUSIONS: Adjusting for measured confounders, SWL is associated with a 2.6-fold higher risk of repeat stone-related interventions. Additional patient-related factors also increase likelihood of retreatment. Intra-operative stent placement is a strong predictor of retreatment, perhaps serving as a marker for complex cases or planned staged procedures. Prospective studies are needed to assess comparative effectiveness of SWL and URS and improve mono-therapeutic success for children with UUTC.
Author List
Ellison JS, Shnorhavorian M, Oron A, Kieran K, Lendvay TS, Merguerian PAAuthor
Jonathan Scott Ellison MD Associate Professor in the Urologic Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentChild
Child, Preschool
Databases, Factual
Female
Follow-Up Studies
Health Information Systems
Humans
Incidence
Infant
Male
Nephrolithiasis
Postoperative Complications
Reoperation
Retrospective Studies
Risk Assessment
Risk Factors
United States
Urologic Surgical Procedures