Faculty Collaboration Database

Antireflux Surgery at National Surgical Quality Improvement Program-Pediatric Hospitals. J Urol 2021 Apr;205(4):1189-1198

Date

11/19/2020

Pubmed ID

33207139

DOI

10.1097/JU.0000000000001439

Scopus ID

2-s2.0-85102723223 (requires institutional sign-in at Scopus site)   5 Citations

Abstract

PURPOSE: This study aims to examine contemporary practice patterns and compare short-term outcomes for vesicoureteral reflux procedures (ureteral reimplant/endoscopic injection) using National Surgical Quality Improvement Program-Pediatric data.

MATERIALS AND METHODS: Procedure-specific variables for antireflux surgery were developed to capture data not typically collected in National Surgical Quality Improvement Program-Pediatric (eg vesicoureteral reflux grade, urine cultures, 31-60-day followup). Descriptive statistics were performed, and logistic regression assessed associations between patient/procedural factors and outcomes (urinary tract infection, readmissions, unplanned procedures).

RESULTS: In total, 2,842 patients (median age 4 years; 76% female; 68% open reimplant, 6% minimally invasive reimplant, 25% endoscopic injection) had procedure-specific variables collected from July 2016 through June 2018. Among 88 hospitals, a median of 24.5 procedures/study period were performed (range 1-148); 95% performed ≥1 open reimplant, 30% ≥1 minimally invasive reimplant, and 70% ≥1 endoscopic injection, with variability by hospital. Two-thirds of patients had urine cultures sent preoperatively, and 76% were discharged on antibiotics. Outcomes at 30 days included emergency department visits (10%), readmissions (4%), urinary tract infections (3%), and unplanned procedures (2%). Over half of patients (55%) had optional 31-60-day followup, with additional outcomes (particularly urinary tract infections) noted. Patients undergoing reimplant were younger, had higher reflux grades, and more postoperative occurrences than patients undergoing endoscopic injections.

CONCLUSIONS: Contemporary data indicate that open reimplant is still the most common antireflux procedure, but procedure distribution varies by hospital. Emergency department visits are common, but unplanned procedures are rare, particularly for endoscopic injection. These data provide basis for comparing short-term complications and developing standardized perioperative pathways for antireflux surgery.

Author List

Johnson EK, Chalmers DJ, Nelson CP, Li I, Iwaniuk M, Grant C, Byrd C, Rangel SJ, Saito JM, Barnhart DC, Hall BL, Vemulakonda VM, Groth TW, Ellison JS, Janzen NK, Hittelman AB, DiCarlo HN, Merguerian PA, Tanaka ST, Prasad MM

Author

Jonathan Scott Ellison MD Associate Professor in the Urologic Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Child
Child, Preschool
Female
Hospitals, Pediatric
Humans
Infant
Male
Postoperative Complications
Practice Patterns, Physicians'
Quality Improvement
United States
Vesico-Ureteral Reflux