Antireflux Surgery at National Surgical Quality Improvement Program-Pediatric Hospitals.
The Journal of urology
Child, Humans, Hospitals, Pediatric, Quality Improvement, Digestive System Surgical Procedures, Societies, Medical
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 follow-up). Descriptive statistics were performed, and logistic regression assessed associations between patient/procedural factors and outcomes (urinary tract infection, readmissions, unplanned procedures).
RESULTS: In total, 2842 patients (median age 4 years; 76% female; 68% open reimplant, 6% minimally invasive reimplant, 25% endoscopic injection) had procedure-specific variables collected from 7/2016-6/2018. 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. 30-day outcomes 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 follow-up, 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.
Johnson, Emilie K; Chalmers, David J; Nelson, Caleb P; Li, Isaac; Iwaniuk, Marie; Grant, Catherine; Byrd, Claudia; Rangel, Shawn J; Saito, Jacqueline M; Barnhart, Douglas C; Hall, Bruce L; Vemulakonda, Vijaya M; Groth, Travis W; Ellison, Jonathan S; Janzen, Nicolette K; Hittelman, Adam B; DiCarlo, Heather N; Merguerian, Paul A; Tanaka, Stacy T; and Prasad, Michaella M, "Antireflux Surgery at National Surgical Quality Improvement Program-Pediatric Hospitals." (2020). Maine Medical Center. 2094.