MP54-11 READMISSION, UNPLANNED EMERGENCY ROOM VISITS, AND SURGICAL RETREATMENT RATES AFTER VESICOURETERAL REFLUX PROCEDURES

Abstract

You have accessJournal of UrologyPediatrics: Urinary Tract Infections/Vesicoureteral Reflux1 Apr 2015MP54-11 READMISSION, UNPLANNED EMERGENCY ROOM VISITS, AND SURGICAL RETREATMENT RATES AFTER VESICOURETERAL REFLUX PROCEDURES Hsin-Hsiao Wang, Rohit Tejwani, John Wiener, and Jonathan Routh Hsin-Hsiao WangHsin-Hsiao Wang More articles by this author , Rohit TejwaniRohit Tejwani 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.2015.02.2034AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The choice between endoscopic injection (EI) and ureteroneocystotomy (UNC) for surgical correction of vesicoureteral reflux (VUR) is controversial. There is little data on VUR surgical outcomes from a population-level perspective. Our objective was to compare post-operative outcomes of both modalities using statewide datasets. METHODS We reviewed the 2007-2010 CA, FL, NC, and UT State Ambulatory Surgery and Service Databases (SASD), State Emergency Department Databases (SEDD) and State Inpatient Databases (SID) to identify pediatric (<= 18y) VUR patients who received either EI or UNC as an initial surgical intervention. States were chosen solely due to data completeness. Patients with neurogenic bladder, ureterocele, megaureter, posterior urethral valves, bladder extrophy, kidney transplant, or prune belly syndrome were excluded. Unplanned readmissions, additional procedures, and ER visits were extracted. Statistical analysis was performed using multivariate logistic regression using GEE to adjust for hospital-level clustering. RESULTS We identified 1,802 UNC and 1,768 EI procedures. Compared with patients underwent EI, patients who underwent UNC were more likely to be younger (4.8 v. 5.8 years, p<0.001), male (30 v. 22%, p<0.001), & publically insured (53 v. 50%, p<0.001). Compared with EI patients, UNC patients had a significantly lower rate of additional anti-reflux procedures within 12 months (19 (1.1%) v. 178 (10%), p<0.001) but a higher rate of 90-day readmissions (109 (6.0%) v. 42 (2.4%), p<0.001) and ER visits (263 (15%) v. 128 (7.2%), p<0.001). After adjusting for age, gender, insurance status, Charlson comorbidity score, treatment year, and hospital clustering, patients treated by UNC remained significantly more likely to be readmitted (OR=2.74, p<0.001) and to have postoperative ER visits (OR=2.12, p<0.001); however, patients treated by EI remained significantly more likely to undergo repeat anti-reflux procedures (OR=12.48, p<0.001). CONCLUSIONS Postoperative readmissions and ER visits were uncommon after any surgical intervention for VUR, but UNC was associated with 2-fold increased odds of readmission and postoperative ER visits. Strikingly, 10% of EI patients required retreatment; compared to UNC pts, this represents 12-fold increased odds of surgical retreatment. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e669 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hsin-Hsiao Wang More articles by this author Rohit Tejwani 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 ...