UP-132 Early postoperative outcomes of ureteric reimplantation surgery for pediatric vesicoureteral reflux: results from the National Surgical Quality Improvement Program Pediatric database
Thursday June 27, 2019 from
TBD
Presenter

Youshan Ding, Canada

Medical Student

Medicine

Western University, Schulich School of Medicine

Abstract

Early postoperative outcomes of ureteric reimplantation surgery for pediatric vesicoureteral reflux: Results from the National Surgical Quality Improvement Program Pediatric Database

Youshan Ding3, Jacob Davidson2, Noah Stern1, Zhan Tao (Peter) Wang1,3, Sumit Dave1,3.

1Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; 2Division of Paediatric Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; 3Faculty of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada

Introduction: Vesicoureteral reflux (VUR) is a common pediatric condition. Surgical options to correct VUR via ureteric reimplantation include open or laparoscopic/robot-assisted ureteric reimplantation (OR/RUR). OR remains the gold standard but use of RUR is increasing. The aim of this study was to use the National Surgical Quality Improvement Program Pediatric (NSQIP-P) database to evaluate early postoperative outcomes of OR vs RUR.

Methods: A secondary analysis was performed on data from NSQIP-P between 2015-2018. Pediatric patients diagnosed with VUR undergoing surgery were captured using International Classification of Diseases and Current Procedural Terminology codes. Statistical analyses included descriptive statistics, independent samples t-test and one-way ANOVA for continuous variables and Chi-square Tests or Fisher’s Exact Test for categorical variables. Multivariate log regression was used to determine predictors of unplanned reoperation within 30-days.

Results: Overall, 6578 VUR patients were identified. Of these, 95% received OR and 5% RUR. Median age at surgery was 4.5 years (IQR 2.3-7.1); 77% were female. Compared to OR, children undergoing RUR were older (5.8 vs 4.5 years; p<0.0001), had longer operations (162 vs 139 mins; p=0.0031) and shorter median hospital stay (LOS) (1 vs 2 days; p<0.0001). RUR was associated with higher rates of unplanned reoperation (4% vs 1%; p=0.0008) and lower rates of urinary tract infection (UTI) (1% vs 3%; p=0.0097). There were no significant differences in rate of unplanned hospital readmission between OR and RUR (5% vs 3%; p=0.1907). On multivariate analysis, younger age and longer operative time were significant predictors of reoperation (Table 1).

Conclusion: OR was associated with lower risk of early complications requiring operative intervention. RUR was associated with longer operative time, shorter LOS and lower UTI rates. Higher risk of early complications needs to be considered when performing RUR in younger children.


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