Return to emergency department after pediatric urology procedures

Naoum, Naimet Kamal; Chua, Michael; Ming, Jessica M.; Santos, Joana Dos; Saunders, Megan; Lopes, Roberto Iglesias; Koyle, Martin A.; Farhat, Walid A.

doi:10.1016/j.jpurol.2018.10.021

Cited by 7 publications

(3 citation statements)

References 22 publications

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“…The readmission rates reported in the present study are similar to or lower than those reported in other studies. A study by Naoum et al [21] reported that ~12% of patients undergoing upper urinary tract procedures, and 16% of those undergoing lower urinary tract procedures (including reconstructive surgeries), returned to the emergency room within 30 days. They also reported that 8.1% of patients who underwent laparoscopic procedures returned to the emergency room within 30 days, but they did not specify the type of procedure, which poses a challenge when attempting to extrapolate these results to everyday practice, especially for robotic surgeons.…”

Section: Discussionmentioning

confidence: 99%

Lessons learned from a single‐surgeon series of paediatric robot‐assisted laparoscopic urological procedures: predictors of high‐grade postoperative complications

et al. 2019

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Objectives To describe postoperative complications after robot‐assisted laparoscopic urological surgery in children, and identify potential predictors of these complications by analysing the outcomes of a large‐volume single‐surgeon experience. Patients and Methods We reviewed our institutional database to identify all robot‐assisted laparoscopy (RAL) cases performed between December 2007 and December 2017. Patients were grouped into three cohorts based on the anatomical location of the procedure: upper urinary tract (kidney and renal pelvis); lower urinary tract (ureter); and lower urinary tract reconstruction with bowel (bladder reconstruction). A descriptive analysis of baseline characteristics, intra‐operative variables and postoperative outcomes was carried out. All complications were graded using the Clavien–Dindo scale, and grouped based on type and time of occurrence (<30, 30–90, >90 days). Multivariable logistic regression analysis was performed to identify predictors of high‐grade complications (Clavien–Dindo grade ≥ III). We also measured complication rates based on year of surgery and surgical caseload. Results Our database included a total of 326 patients, of whom 57% (n = 186) underwent upper urinary tract procedures, 30% (n = 97) ureteric procedures, and 13% bladder reconstruction. The median follow‐up for each procedure was 13, 11 and 57 months, respectively. Of the total, 10 cases were converted to an open approach and excluded from further analysis. The most common types of complication in all groups were infections (urinary tract infections) and urinary complications (urine leaks and urolithiasis). Bladder reconstructive procedures, which require the use of bowel, presented the highest rate of high‐grade complications (32%). Length of hospital stay (LOS; odds ratio [OR] 1.33, confidence interval [CI] 1.16–1.53), estimated blood loss (EBL) in surgery (OR 1.01, CI 1.002–1.019) and operating time (OR 1.004, CI 1.002–1.006) were all associated with increased odds of high‐grade complications on multivariate analysis (P < 0.05). Conclusions In this single‐surgeon series, we have described the most commonly encountered complications after RAL in paediatric urology, finding rates similar to the complication rates reported in the current literature on other surgical approaches. In addition, LOS, operating time and EBL, which are probable surrogates of case complexity, were associated with increased odds of high‐grade complications.

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Section: Discussionmentioning

confidence: 99%

Lessons learned from a single‐surgeon series of paediatric robot‐assisted laparoscopic urological procedures: predictors of high‐grade postoperative complications

et al. 2019

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“…In a large population-based study by Kulaylat et al including over 14,800 ambulatory pediatric urologic procedures, the 30-day readmission rate was 2.6%. 11 A comprehensive study by Naoum et al including pediatric urology procedures in the Canadian health care system reported a rate of 8.5% returning to the ER and a 1.3% readmission rate; 12 this was relatively high in comparison to a 0.54% rate of readmission reported by Arlen et al from a single center in a U.S. health care system. 13 In our study the ER visit rate was 6.7% and readmission rate was 3.7%.…”

Section: Discussionmentioning

confidence: 93%

Outpatient Robotic Surgery in Pediatric Urology: Assessment of Feasibility and Short-Term Safety

et al. 2022

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Purpose: Robotic reconstructive and extirpative procedures have been widely utilized for surgical management of various conditions in pediatric urology. Outpatient laparoscopic surgery has become the standard in cases of orchidopexy, inguinal hernia repair and varicocelectomy. There is a growing body of evidence that robotic surgery for more complex conditions can also be performed in an outpatient setting. The aim of the study was to assess the short-term safety and feasibility of robotic reconstructive and extirpative procedures for various pediatric urological conditions as scheduled outpatient procedures. Materials and Methods: Demographic information and perioperative data were prospectively collected in an institutional database for all pediatric patients undergoing outpatient robotic surgery from June 2012 to December 2019. Primary outcomes included rates of 30-day complications, emergency room visits and readmissions. Results: A total of 135 pediatric patients underwent robotic procedures in an outpatient setting. The majority underwent pyeloplasty (62) or extravesical ureteral reimplantation (55). Ten patients underwent ureteroureterostomy and 8 patients underwent extirpative procedures (nephrectomy, hemi-nephrectomy). Median age at surgery was 62 months (IQR, 27e99), median weight was 20 kg (IQR, 12e30) and median body mass index was 17 (IQR, 15e18). During the 30day followup period there were 9 complications (6.7%), of which only 1 (0.7%) was high grade (Clavien-Dindo 3). There were 9 emergency room visits (6.7%) including 5 cases of readmission (3.7%). Conclusions: Robotic reconstructive and extirpative procedures in pediatric urology can be safely performed as scheduled outpatient procedures in the majority of patients, obviating the need for routine inpatient care.

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“…With children being less communicative and less accurate historians of their illness than adults, caregivers must often rely on subjective assessments, such as perceived well-being, appetite, or fatigue, as indicators of abnormal recovery and decide whether or not to seek care 4 – 6 . This model of post-discharge care has resulted in both unwarranted healthcare use 7 – 9 and delays in seeking care leading to serious complications 10 – 15 . For example, studies have shown that 30–50% of emergency department visits that occur after pediatric appendectomy, the most common inpatient pediatric procedure, are potentially avoidable 7 , 8 .…”

Section: Introductionmentioning

confidence: 99%

Applying machine learning to consumer wearable data for the early detection of complications after pediatric appendectomy

Ghomrawi,

O’Brien,

Carter

et al. 2023

npj Digit. Med.

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When children are discharged from the hospital after surgery, their caregivers often rely on subjective assessments (e.g., appetite, fatigue) to monitor postoperative recovery as objective assessment tools are scarce at home. Such imprecise and one-dimensional evaluations can result in unwarranted emergency department visits or delayed care. To address this gap in postoperative monitoring, we evaluated the ability of a consumer-grade wearable device, Fitbit, which records multimodal data about daily physical activity, heart rate, and sleep, in detecting abnormal recovery early in children recovering after appendectomy. One hundred and sixty-two children, ages 3–17 years old, who underwent an appendectomy (86 complicated and 76 simple cases of appendicitis) wore a Fitbit device on their wrist for 21 days postoperatively. Abnormal recovery events (i.e., abnormal symptoms or confirmed postoperative complications) that arose during this period were gathered from medical records and patient reports. Fitbit-derived measures, as well as demographic and clinical characteristics, were used to train machine learning models to retrospectively detect abnormal recovery in the two days leading up to the event for patients with complicated and simple appendicitis. A balanced random forest classifier accurately detected 83% of these abnormal recovery days in complicated appendicitis and 70% of abnormal recovery days in simple appendicitis prior to the true report of a symptom/complication. These results support the development of machine learning algorithms to predict onset of abnormal symptoms and complications in children undergoing surgery, and the use of consumer wearables as monitoring tools for early detection of postoperative events.

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Return to emergency department after pediatric urology procedures

Cited by 7 publications

References 22 publications

Lessons learned from a single‐surgeon series of paediatric robot‐assisted laparoscopic urological procedures: predictors of high‐grade postoperative complications

Lessons learned from a single‐surgeon series of paediatric robot‐assisted laparoscopic urological procedures: predictors of high‐grade postoperative complications

Outpatient Robotic Surgery in Pediatric Urology: Assessment of Feasibility and Short-Term Safety

Applying machine learning to consumer wearable data for the early detection of complications after pediatric appendectomy

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