Outcomes after pediatric ureteral reimplantation: A population based analysis

Hao G. Nguyen, Karim Chamie, Khanh G. Nguyen, Blythe Durbin-Johnson, Eric A Kurzrock

Research output: Contribution to journalArticle

7 Scopus citations

Abstract

Purpose: Pediatric urology literature is often biased toward single, high volume institutions. We determined the impact of patient, surgeon and hospital characteristics on immediate outcomes for children undergoing ureteral reimplantation. Materials and Methods: We queried the University Health-System Consortium Clinical Data Base to identify a pediatric population who underwent ureteroneocystostomy between 2004 and 2009. We measured the association of the outcome variables length of stay, number of days in the intensive care unit and complication rates on the independent variables of age, gender, race, insurance status, year of surgery, and surgeon and hospital characteristics. The data were analyzed using multiple logistic, Poisson and Poisson hurdle model regression analyses incorporating random effects for surgeon and hospital. Results: We identified 5,668 subjects who underwent ureteroneocystostomy. Compared with patients treated by high volume providers, those treated by low volume surgeons (less than 13 cases per year) had a longer length of stay (47%), higher odds of intensive care unit admission (OR 8.1), longer intensive care unit stays (103%) and higher rate of surgical related complications (162%). Other independent variables of male gender, nonwhite race and prior comorbidities were independently associated with longer length of stay, higher intensive care unit admissions and higher risk of complications. Conclusions: Surgeon volume, not hospital volume, is an important and consistent predictor of length of stay, intensive care unit admissions, intensive care unit days and complication rate after ureteroneocystostomy. These findings posit that the short length of stay, low intensive care unit admission rate and low complication rate reported in the literature may not be generalizable, but rather limited to higher volume surgeons.

Original languageEnglish (US)
Pages (from-to)2292-2297
Number of pages6
JournalJournal of Urology
Volume185
Issue number6
DOIs
StatePublished - Jun 2011

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Keywords

  • treatment outcome
  • vesico-ureteral reflux

ASJC Scopus subject areas

  • Urology

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