MP47-09 OVER 5,000 HYPOSPADIAS REPAIRS: IS CAUDAL ANESTHESIA ASSOCIATED WITH COMPLICATIONS?

Abstract

You have accessJournal of UrologyPediatric Urology III (MP47)1 Sep 2021MP47-09 OVER 5,000 HYPOSPADIAS REPAIRS: IS CAUDAL ANESTHESIA ASSOCIATED WITH COMPLICATIONS? Jonathan Hu, Craig Belon, Niroop Ravula, Blythe Durbin-Johnson, and Eric Kurzrock Jonathan HuJonathan Hu More articles by this author , Craig BelonCraig Belon More articles by this author , Niroop RavulaNiroop Ravula More articles by this author , Blythe Durbin-JohnsonBlythe Durbin-Johnson More articles by this author , and Eric KurzrockEric Kurzrock More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002068.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is controversy surrounding the association between caudal epidural blocks and complication rates after hypospadias repair. Single-center and/or low volume studies may lead to underpowered data and/or confounding variables. We hypothesized that caudal anesthesia is associated with more complex hypospadias surgery and not associated with increased rates of reoperation after primary repair. METHODS: The Clinical Practice Solutions Center database was used to query patients who received a primary hypospadias repair between 2009 and 2010. Primary hypospadias repair was further categorized as meatal advancement and glanduloplasty (MAGPI), distal, one-stage proximal, and one-stage perineal repair. Anesthesia coding was evaluated to identify those who received a caudal epidural block. Any secondary surgery was captured between 2009 and 2019 and the types of secondary surgeries were identified. Variables such as caudal anesthesia, age, insurance type, surgeon volume, and surgeon years in practice were analyzed with mixed effects multiple logistic regression models in order to incorporate for random effects of surgeon and institution. RESULTS: Our database identified 5,178 boys who had primary hypospadias repair. There were 84 surgeons at 46 institutions. 1,245 underwent primary MAGPI (24%), 3,466 distal (67%), 409 proximal (0.08%), and 58 perineal hypospadias repair (0.01%). 1,331 individuals in our cohort received caudal anesthesia (25.7%). The percentage of caudal anesthesia performed by each type of primary surgery was 21% for MAGPI, 28% for distal, 23% for proximal, and 16% for perineal hypospadias repair. Utilization of caudal anesthesia was not associated with type of primary surgery (p=0.19). Adjusting for all other variables, increased patient age was associated with decreased usage of caudal anesthesia OR 0.985 CI [0.98, 0.989] p<0.001). Increased surgeon years in practice was marginally associated with decreased usage of caudal anesthesia (OR 0.974 CI [0.947, 0.999] p=0.04). There was no association of caudal block and secondary surgery after primary MAGPI, (OR 1.104 CI [0.617, 1.976], p=0.74), distal (OR 1.127 CI [0.85, 1.495] p=0.41), proximal (OR 1.625 CI [0.852, 3.101] p=0.14), or perineal hypospadias repair (OR 0.692 CI [0.097, 4.919] p=0.71). CONCLUSIONS: This large, multi-institution study demonstrates that the use of caudal anesthesia was not associated with more complex hypospadias surgery and was not associated with increased rates of secondary surgery after primary hypospadias repair. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e826-e826 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jonathan Hu More articles by this author Craig Belon More articles by this author Niroop Ravula More articles by this author Blythe Durbin-Johnson More articles by this author Eric Kurzrock More articles by this author Expand All Advertisement Loading ...