National Trends in Secondary Procedures Following Pediatric Pyeloplasty
Autor: | Sarah K. Holt, Thomas S. Lendvay, Jonathan D. Harper, John L. Gore, Ryan S. Hsi, Geolani W. Dy |
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Rok vydání: | 2016 |
Předmět: |
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 |
Zdroj: | Journal of Urology. 195:1209-1214 |
ISSN: | 1527-3792 0022-5347 |
Popis: | 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. |
Databáze: | OpenAIRE |
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