Racial Variation in Timing of Pyeloplasty: Prenatal Versus Postnatal Diagnosis

Routh, Jonathan C.; Pennison, Melanie; Rosoklija, Ilina; Dobbins, Sarah; Kokorowski, Paul; Hubert, Katherine C.; Huang, Lin; Nelson, Caleb P.

doi:10.1016/j.juro.2011.07.111

Cited by 5 publications

(7 citation statements)

References 14 publications

(12 reference statements)

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“…However, race has not been previously well examined as a predictor of outcomes in pediatric urology, with studies either excluding race from their analyses 38 for unclear 6 reasons or being limited, by the data sets used, to exploring associations with timing of surgery rather than with complications. [39][40][41] Additionally, multiple risk score nomograms in the pediatric surgery literature did not specifically assess race as a predictor of outcomes, [42][43][44] which highlights the clinical importance of our finding.…”

Section: Discussionmentioning

confidence: 88%

Race and 30-Day Morbidity in Pediatric Urologic Surgery

2016

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Section: Discussionmentioning

confidence: 88%

Race and 30-Day Morbidity in Pediatric Urologic Surgery

2016

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“…Previous work conducted by Chu et al found that Black children had a statistically significant higher odds ratio of having postoperative complications following pediatric urologic procedures [ 13 ]. Conversely, multiple studies have documented that non-White children tend to have an earlier surgical intervention for ureteropelvic junction obstruction when presenting postnatally [ 14 - 16 ]. Among their findings, Routh et al also found that non-White patients were more likely to have surgery in the first year of life.…”

Section: Discussionmentioning

confidence: 99%

“…Among their findings, Routh et al also found that non-White patients were more likely to have surgery in the first year of life. They posited that this might be due to decreased access to prenatal care causing more emergent surgery to be warranted [ 14 ]. Although not seen in our linear model, our bivariate analysis aligns with their previous findings that Black patients tend to have a shorter time to surgery intervals than White patients.…”

Section: Discussionmentioning

confidence: 99%

Impact of Healthcare Disparities on Time to Surgery for Pediatric Urologic Patients

Schroeder¹,

Samson²,

Kerns³

et al. 2022

Cureus

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Introduction Healthcare disparities are differences in health outcomes reflecting social inequalities. We aim to identify healthcare disparities in pediatric urologic patients by analyzing the time from surgical scheduling to completion of procedure at a single center and identify variables associated with increased time to surgery. Materials and methods We reviewed all patients aged 0-18 years who underwent surgery with one of three pediatric urologists at our institution from January 1, 2018, to December 31, 2019. We collected or calculated variables including age, sex, race, ethnicity, caregivers’ primary language, insurance status, zip code, median distance to hospital, clinic visit date, and time to surgery (calculated as days between surgery request and date of surgery). Data analysis included bivariate analysis and linear regression with all variables of interest presented with 95% confidence intervals (CIs), where log-transformed time to surgery was the outcome. Because the practice at our institution is to delay elective surgeries until after six months of age, we excluded patients who were less than six months of age at the time of surgery request date. Results A total of 697 patients were included in the final analysis. Patients’ caregivers who spoke languages other than English or Spanish had a lower model-adjusted mean log-days to surgery (−0.44; 95% CI: −0.85, −0.03) relative to English-speaking caregivers. Uninsured patients had increased time to surgery compared to Medicaid patients (0.28; 95% CI: 0.03, 0.53). Income was also associated with increased time to surgery, meaning patients from higher-income backgrounds had a longer time to surgery (0.04; 95% CI: 0.00, 0.08). Conclusions In our patient population, primary language spoken and insurance status were associated with increases in time from initial evaluation to surgical intervention among pediatric patients undergoing urologic surgery. Additional research is needed to better understand variations in access to pediatric urologic surgery.

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“…Notably, a prior study determined that the racial difference in pyeloplasty timing is limited to children who present after birth. 9 Our patient population was overwhelmingly diagnosed prenatally, potentially eliminating the source of racial variation and likely reflecting the growing prevalence of prenatal diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…This lack of uniform guidelines may also be associated with previously described demographic variations in the timing of pyeloplasty. 8,9 These studies raise the potential for racial differences in the natural history of suspected UPJO or true demographic health disparities. However, the absence of detailed clinical data or an observational control group in these studies limits the ability to determine their true impact.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with surgical intervention in children with high-grade congenital hydronephrosis

Chalmers

Siomos

Gilsdorf

et al. 2014

Journal of Clinical Urology

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Purpose: A lack of uniform guidelines regarding ureteropelvic junction obstruction may be associated with demographic variations in pyeloplasty timing. This study objective was to determine if children who undergo surgery are more likely to be of minority race. Materials and methods: Children with Society for Fetal Urology (SFU) 3-4 hydronephrosis were reviewed. Demographic and clinical characteristics were abstracted. Bivariable associations between clinical/demographic characteristics and pyeloplasty versus observation as well as follow-up findings were assessed with chi-square testing. The bivariable relationship between race and time from first clinic visit to surgery was evaluated by Kaplan-Meier curve. Multivariable logistic regression was performed to estimate the relationship between clinical characteristics and management decision. Results: Thirty-nine patients underwent pyeloplasty and 50 were observed. There were no differences in demographics, including race/ethnicity. Factors associated with surgery included higher SFU grade (p = 0.01), preoperative MAG3 (p = 0.02), and T½ >20 (p = 0.01). On multivariate analysis, MAG3 T½ >20 was associated with surgery (OR = 0.20, 95% CI: 0.07-0.61). Median time to surgery for whites versus non-whites was not significant (232 vs 208 days, p = 0.16). Conclusions: In our cohort, the decision to perform pyeloplasty is associated with clinical rather than demographic characteristics. Despite controversy regarding T½ interpretation, delayed radiotracer clearance remained a significant predictor of surgery.

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Racial Variation in Timing of Pyeloplasty: Prenatal Versus Postnatal Diagnosis

Cited by 5 publications

References 14 publications

Race and 30-Day Morbidity in Pediatric Urologic Surgery

Race and 30-Day Morbidity in Pediatric Urologic Surgery

Impact of Healthcare Disparities on Time to Surgery for Pediatric Urologic Patients

Factors associated with surgical intervention in children with high-grade congenital hydronephrosis

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