National Trends in Secondary Procedures Following Pediatric Pyeloplasty

Abstract

Purpose Although reported success rates after pediatric pyeloplasty to correct ureteropelvic junction are high, failure may require intervention. We sought to characterize the incidence and timing of secondary procedures after pediatric pyeloplasty using a national employer based insurance database. Materials and Methods Using the MarketScan® database we identified patients 0 to 18 years old who underwent pyeloplasty from 2007 to 2013 with greater than 3 months of postoperative enrollment. Secondary procedures following the index pyeloplasty were identified by CPT codes and classified as stent/drain, endoscopic, pyeloplasty, nephrectomy or transplant. The risk of undergoing a secondary procedure was ascertained using Cox proportional hazards models adjusting for demographic and clinical characteristics. Results We identified 1,976 patients with a mean ± SD followup of 23.9 ± 19.8 months. Overall 226 children (11.4%) had undergone at least 1 post-pyeloplasty procedure. The first procedure was done within 1 year in 87.2% of patients with a mean postoperative interval of 5.9 ± 11.1 months. Stents/drains, endoscopic procedures and pyeloplasties were noted in 116 (5.9%), 34 (1.7%) and 71 patients (3.1%), respectively. Length of stay was associated with undergoing a secondary procedure. Compared with 2 days or less the HR of 3 to 5 and 6 days or greater was 1.65 and 3.94 (p = 0.001 and <0.001, respectively). Conclusions Following pediatric pyeloplasty 1 of 9 patients undergoes at least 1 secondary procedure with the majority performed within the first year. One of 11 patients undergoes intervention more extensive than placement of a single stent or drain, requiring management strategies that generally signify recurrent or persistent obstruction. Estimates of pyeloplasty success in this national data set are lower than in other published series.

Has the robot caught up? National trends in utilization, perioperative outcomes, and cost for open, laparoscopic, and robotic pediatric pyeloplasty in the United States from 2003 to 2015

“…Success rates following pediatric pyeloplasty have been reported as greater than 90% for both approaches, while complications have been reported in 0–18% of cases with additional procedures occurring in 7.6% [17,27–30]. Our rate of complications was consistent with these aforementioned studies.…”

Resolution of hydronephrosis after pyeloplasty in children

“…Our results suggest that the vast majority of cases that resolve, do so within 12 months from surgery, whereas hydronephrosis persisting beyond 12 months after surgery is less likely to resolve. Since the improvement of hydronephrosis is very small between the first and second year after surgery, the value of follow-up beyond 12 months could be questioned since most failures seem to happen within the first year as seen in the present and in other larger cohorts [7,20,21]. However, there are also studies indicating longer time before failure as in the study by Davis et al [22], and in the study by Jacobsson et al [23] in which many were also asymptomatic.…”

Surgery for Pediatric Ureteropelvic Junction Obstruction—Comparison of Outcomes in Relation to Surgical Technique and Operating Discipline in Germany

“…15,26,31 Moreover, the frequency of re-do pyeloplasties (2.2%) as a main complication was comparable to that of others (3.1%) underlining the representativeness of our study cohort and the good quality of medical care for UPJO in Germany. 32 To date, there is no defined specialization for pediatric urology in Germany. Training can be accomplished in either pediatric surgery or urologic department.…”