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National Trends in Secondary Procedures Following Pediatric Pyeloplasty
- Source :
- Journal of Urology. 195:1209-1214
- Publication Year :
- 2016
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2016.
-
Abstract
- Although reported success rates after pediatric pyeloplasty to correct ureteropelvic junction are high, failure may require intervention. We sought to characterize the incidence and timing of secondary procedures after pediatric pyeloplasty using a national employer based insurance database.Using the MarketScan® database we identified patients 0 to 18 years old who underwent pyeloplasty from 2007 to 2013 with greater than 3 months of postoperative enrollment. Secondary procedures following the index pyeloplasty were identified by CPT codes and classified as stent/drain, endoscopic, pyeloplasty, nephrectomy or transplant. The risk of undergoing a secondary procedure was ascertained using Cox proportional hazards models adjusting for demographic and clinical characteristics.We identified 1,976 patients with a mean ± SD followup of 23.9 ± 19.8 months. Overall 226 children (11.4%) had undergone at least 1 post-pyeloplasty procedure. The first procedure was done within 1 year in 87.2% of patients with a mean postoperative interval of 5.9 ± 11.1 months. Stents/drains, endoscopic procedures and pyeloplasties were noted in 116 (5.9%), 34 (1.7%) and 71 patients (3.1%), respectively. Length of stay was associated with undergoing a secondary procedure. Compared with 2 days or less the HR of 3 to 5 and 6 days or greater was 1.65 and 3.94 (p = 0.001 and0.001, respectively).Following pediatric pyeloplasty 1 of 9 patients undergoes at least 1 secondary procedure with the majority performed within the first year. One of 11 patients undergoes intervention more extensive than placement of a single stent or drain, requiring management strategies that generally signify recurrent or persistent obstruction. Estimates of pyeloplasty success in this national data set are lower than in other published series.
- Subjects :
- Male
Reoperation
Pyeloplasty
medicine.medical_specialty
Adolescent
Urology
medicine.medical_treatment
030232 urology & nephrology
Ureteropelvic junction
Urologic Surgical Procedure
Article
03 medical and health sciences
0302 clinical medicine
medicine
Humans
Kidney Pelvis
Treatment Failure
Child
Hydronephrosis
Proportional hazards model
business.industry
Incidence (epidemiology)
Infant
Stent
medicine.disease
United States
Nephrectomy
Surgery
medicine.anatomical_structure
Child, Preschool
030220 oncology & carcinogenesis
Urologic Surgical Procedures
Female
business
Ureteral Obstruction
Subjects
Details
- ISSN :
- 15273792 and 00225347
- Volume :
- 195
- Database :
- OpenAIRE
- Journal :
- Journal of Urology
- Accession number :
- edsair.doi.dedup.....f63b8e4e4db1e833a17379082bb47b40