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This study aims to examine contemporary practice patterns and compare short-term outcomes for vesicoureteral reflux procedures (ureteral reimplant/endoscopic injection) using National Surgical Quality Improvement Program-Pediatric data.Procedure-specific variables for antireflux surgery were developed to capture data not typically collected in National Surgical Quality Improvement Program-Pediatric (eg vesicoureteral reflux grade, urine cultures, 31-60-day followup). Descriptive statistics were performed, and logistic regression assessed associations between patient/procedural factors and outcomes (urinary tract infection, readmissions, unplanned procedures).In total, 2,842 patients (median age 4 years; 76% female; 68% open reimplant, 6% minimally invasive reimplant, 25% endoscopic injection) had procedure-specific variables collected from July 2016 through June 2018. Among 88 hospitals, a median of 24.5 procedures/study period were performed (range 1-148); 95% performed ≥1 open reimplant, 30% ≥1 minimally invasive reimplant, and 70% ≥1 endoscopic injection, with variability by hospital. Two-thirds of patients had urine cultures sent preoperatively, and 76% were discharged on antibiotics. Outcomes at 30 days included emergency department visits (10%), readmissions (4%), urinary tract infections (3%), and unplanned procedures (2%). Over half of patients (55%) had optional 31-60-day followup, with additional outcomes (particularly urinary tract infections) noted. Patients undergoing reimplant were younger, had higher reflux grades, and more postoperative occurrences than patients undergoing endoscopic injections.Contemporary data indicate that open reimplant is still the most common antireflux procedure, but procedure distribution varies by hospital. Emergency department visits are common, but unplanned procedures are rare, particularly for endoscopic injection. These data provide basis for comparing short-term complications and developing standardized perioperative pathways for antireflux surgery.

Among some populations access to neonatal circumcision has become increasingly limited despite evidence of its benefits. This study examines national neonatal circumcision trends before and after the 2012 American Academy of Pediatrics recommendation for neonatal circumcision reimbursement.A retrospective cohort study of boys aged 28 days or less was conducted using data from the Kids' Inpatient Database (2003 to 2016). Boys who underwent neonatal circumcision prior to discharge were compared to boys who did not. Boys with coagulopathies, penile anomalies or a history of prematurity were excluded.An estimated 8,038,289 boys comprised the final cohort. Boys were primarily White (53.7%), privately insured (49.1%) and cared for at large (60.8%) teaching (49.4%) hospitals in metropolitan areas (84.1%). While 55.0% underwent circumcision prior to discharge, neonatal circumcision rates decreased significantly over time (p0.0001). Black (68.0%) or White (66.0%) boys, boys in the highest income quartile (60.7%) and Midwestern boys (75.0%) were most likely to be circumcised. Neonatal circumcision was significantly more common among privately (64.9%) than publicly (44.6%) insured boys after controlling for demographics, region, hospital characteristics and year (p0.0001). The odds of circumcision over time were not significantly different in the years before vs after 2012 (p=0.28).Among approximately 8 million boys sampled over a 13-year period 55.0% underwent neonatal circumcision. The rate of neonatal circumcision varied widely by region, race and socioeconomic status. The finding that boys with public insurance have lower circumcision rates in all years may be related to lack of circumcision access for boys with public insurance.

Children are particularly vulnerable to the harmful effects of medical radiation, and children with urolithiasis comprise a group that may undergo repeated radiation intensive imaging tests. We sought to characterize imaging practices for children presenting to the emergency department with suspected urolithiasis and to determine factors associated with the choice of imaging study.Using the 2006 to 2010 Nationwide Emergency Department Sample, we conducted a retrospective cohort study of patients younger than 18 years presenting with suspected urolithiasis. We determined imaging practices for visits to emergency departments where billing codes for computerized tomography and ultrasound were reliably reported. Logistic regression was used to delineate patient and hospital level factors associated with the use of computerized tomography vs ultrasound.We identified 18,096 pediatric visits for suspected urolithiasis in the 1,191 Nationwide Emergency Department Sample emergency departments with reliable imaging codes. A total of 11,215 patients underwent computerized tomography alone, ultrasound alone or both. Of the patients 9,773 (87%) underwent computerized tomography alone. Computerized tomography use peaked in 2007 and declined thereafter. On multivariate analysis several factors were associated with the use of computerized tomography alone, including smaller proportion of pediatric patients treated at the emergency department, older age, location in the Midwest or South, evaluation at a nonteaching hospital and visit on a weekend.Computerized tomography use is highly prevalent for children presenting with suspected urolithiasis. The lowest computerized tomography use is in emergency departments that care for more children. Ultrasound is used infrequently regardless of site. Awareness regarding risks of computerized tomography and consideration of alternatives including ultrasound are warranted in caring for these patients.