Performance of Open Renal and Bladder Surgery at a Freestanding Pediatric Surgery Center

Abstract

More ambulatory urological surgeries are being performed in children due to innovations in techniques and trends in medical care. Pediatric ambulatory surgery centers are seeing more complex procedures that were traditionally hospital based. A total of 343 open renal and bladder procedures were performed by a single pediatric urologist at a freestanding pediatric surgery center (12 miles from a pediatric hospital) between July 2003 and October 2009. Charts were analyzed to determine the demographics and complications necessitating hospitalization within 48 hours of discharge home. During the study period 28 children (mean age 1.62 years, range 4 months to 6 years) underwent nephrectomy, 50 (2.92 years, 3 months to 12 years) underwent pyeloplasty, 216 (4.01 years, 8 months to 21 years) underwent simple ureteral reimplantation and 49 underwent complex ureteral reimplantation (2.79 years, 5 months to 12 years). Two children were acutely transferred to the hospital, 1 for pain management and 1 for respiratory distress. Two additional children were hospitalized within 48 hours, 1 due to partial ureteral obstruction, and 1 due to dehydration and urinary tract infection. All 4 of these patients underwent simple reimplantation surgery. Carefully selected children undergoing open renal and bladder procedures can be expected to be discharged home on the same day. Older children, those with significant comorbidities and those undergoing procedures later in the day may not be ideal outpatient candidates. Nephrectomy, pyeloplasty and ureteral reimplantation are excellent outpatient procedures for most children.