MP34-20 OPEN VS. MINIMALLY INVASIVE SURGICAL APPROACHES: ASSOCIATED POST-OPERATIVE COMPLICATIONS OF PEDIATRIC UROLOGIC SURGERY IN THE UNITED STATES

Abstract

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology III1 Apr 2016MP34-20 OPEN VS. MINIMALLY INVASIVE SURGICAL APPROACHES: ASSOCIATED POST-OPERATIVE COMPLICATIONS OF PEDIATRIC UROLOGIC SURGERY IN THE UNITED STATES Rohit Tejwani, Brian Young, Hsin-Hsiao Wang, Steven Wolf, John Wiener, and Jonathan Routh Rohit TejwaniRohit Tejwani More articles by this author , Brian YoungBrian Young More articles by this author , Hsin-Hsiao WangHsin-Hsiao Wang More articles by this author , Steven WolfSteven Wolf More articles by this author , John WienerJohn Wiener More articles by this author , and Jonathan RouthJonathan Routh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1578AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Advances in laparoscopic and robotic technology and a paradigm shift amongst providers and families favoring preferential use of less-invasive surgical approaches in children have resulted in a marked rise in the availability and use of minimally invasive surgery (MIS) in pediatric urology. Despite substantial differences in invasiveness, cost, and intra/post-operative characteristics, studies directly comparing MIS to open approaches in children are lacking, and the equivocality of outcomes between these modalities is unknown. We sought to compare post-operative complication rates between MIS and open pediatric urologic procedures using a validated nationwide dataset. METHODS We retrospectively reviewed the Nationwide Inpatient Sample (1998-2012) for pediatric (≤18 years) admissions for MIS/open ureteral reimplant, ureterureterostomy, pyeloplasty, radical/partial nephrectomy, appendicovesicostomy, enterocystoplasty, and sling, as identified by ICD-9-CM codes. Admissions from centers performing ≤5 MIS procedures during the period queried were excluded to reduce bias and ensure subject comparability. Admission-associated in-hospital post-operative complications as defined by the National Surgical Quality Improvement Program (NSQIP) were identified. Missing demographic values were replaced using multiple imputation. Wald chi-square test and ANOVA were used to compare discrete and continuous variables respectively, and Propensity Scores were used to match patients by surgery type. RESULTS A total of 14,631 encounters from 59 qualifying centers were identified. Patients undergoing MIS were more likely to be older (7.81 vs. 4.67; p<0.0001), male (52% vs. 43%; p=0.0026) and seen in an urban non-teaching setting (3.9% vs. 2.7%; p=0.02). MIS encounters were less likely to result in NSQIP-defined post-operative complications (7% vs. 9.1%; p=0.005). Adjusting for other covariates, patients who received MIS were 0.73 times as likely to experience a post-operative complication compared to open surgery (p=0.0302). A decrease in complication rates over time as hospitals became specialized (i.e. performed ≥5 MIS) was noted, though was not statistically significant (p=0.49). CONCLUSIONS Over a 14 year period, MIS was associated with a lower NSQIP-defined post-operative complication rate at centers that had performed ≥5 pediatric urologic MIS procedures, which may be reflective of improvements in technology and surgeon proficiency as MIS has become more common nationwide. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e479 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Rohit Tejwani More articles by this author Brian Young More articles by this author Hsin-Hsiao Wang More articles by this author Steven Wolf More articles by this author John Wiener More articles by this author Jonathan Routh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...