Do caudal blocks influence revision surgery rates following hypospadias repair?

Abstract

There has been controversy in recent literature that caudal anaesthesia may increase revision surgery rates following hypospadias repair. We sought to investigate this using a large, multi-surgeon series. A prospectively maintained database of consecutive patients undergoing primary hypospadias repairs under the supervision of 8 different paediatric surgeons at our centre was queried for the following potential risk factors: age at surgery, American Society of Anaesthesiologist’s (ASA) grade, hypospadias Type, type of surgery, caudal or penile block and training level of primary operator. Revision surgery was defined as reoperation for fistulas, dehiscence, strictures or meatal stenosis. Univariate and Multivariate analysis was performed using logistic regressions analyses. Between January 2015 to December 2018, 258 consecutive patients had primary repairs for distal (n=188), midshaft (n=25) and proximal (n=45) hypospadias. Patients were aged between 5 months to 15 years at operation. Median age was 14 months. Revision surgery was performed for 48/258 (18.6%). Indications were fistula (30/258, 11.6%), meatal stenosis or strictures (13/258, 5.0%) and dehiscence (7/258, 2.7%). Caudal blocks were not significant for revision surgery risk on univariate and multivariate analysis (HR 0.56, p = 0.07). However, when distal hypospadias was analysed, caudal blocks were significant for reduced rates of revision surgery on multivariate analysis (HR 0.52, p = 0.04). ASA 2-3 Grade was an independent risk factor on multivariate analysis for revision surgery (HR 2.30, p = 0.02). Our finding that caudal blocks may be associated with lower revision surgery rates in distal hypospadias contrasts with the findings of some authors and needs further investigation. To our knowledge, our study is the first to identify ASA Grade as an independent risk factor for revision surgery following hypospadias repair.