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National trends in augmentation cystoplasty in the 2000s and factors associated with patient outcomes
Bruce J Schlomer1, Kara Saperston, Laurence Baskin
1Department of Urology, University of California San Francisco, San Francisco, California.
Insights
Pediatric augmentation cystoplasty rates declined 25% in the 2000s, with shorter hospital stays. Older age and bladder exstrophy-epispadias complex increased complication risks and length of stay.
Area of Science:
- Pediatric Urology
- Health Services Research
- Surgical Outcomes
Background:
- Augmentation cystoplasty is a significant surgical procedure in pediatric urology.
- Understanding trends and factors influencing outcomes is crucial for improving patient care.
Purpose of the Study:
- To analyze national trends in pediatric augmentation cystoplasty from 2000-2009.
- To identify patient and hospital factors associated with length of stay, hospital charges, and postoperative complications.
Main Methods:
- Utilized data from the 2000-2009 Kids' Inpatient Database.
- Employed hierarchical models to assess factors influencing outcomes.
- Evaluated trends in procedure volume, patient demographics, and hospital characteristics.
Main Results:
- Estimated augmentation cystoplasty procedures decreased by 25% (792 in 2000 to 595 in 2009).
- Mean length of stay reduced by approximately 1 day (10.5 to 9.2 days).
- 30% of patients experienced a complication; older age and bladder exstrophy-epispadias complex were linked to longer stays and higher complication rates.
Conclusions:
- Pediatric augmentation cystoplasty rates and lengths of stay declined during the 2000s.
- Changing practice patterns may explain the observed decrease in procedure volume.
- Patient factors like older age and specific diagnoses significantly impact outcomes, highlighting areas for targeted interventions.
Purpose:
Augmentation cystoplasty is a major surgery performed by pediatric urologists. We evaluated national estimates of children undergoing augmentation cystoplasty in the United States for trends during the 2000s, and analyzed patient and hospital factors associated with outcomes.
Materials And Methods:
Patients who underwent augmentation cystoplasty registered in the 2000 to 2009 Kids' Inpatient Database were included. Estimates of total number of augmentation cystoplasties performed and patient and hospital characteristics were evaluated for trends. Hierarchical models were created to evaluate patient and hospital factors associated with length of stay, total hospital charges and odds of having a postoperative complication.
Results:
An estimated 792 augmentation cystoplasties were performed in 2000, which decreased to 595 in 2009 (p = 0.02). Length of stay decreased from 10.5 days in 2000 to 9.2 days in 2009 (p = 0.04). A total of 1,622 augmentation cystoplasties were included in the hierarchical models and 30% of patients had a complication identified. Patient factors associated with increased length of stay and increased odds of any complication included bladder exstrophy-epispadias complex diagnosis and older age. Pediatric hospitals had 31% greater total hospital charges (95% CI 7-55).
Conclusions:
The estimated number of augmentation cystoplasties performed in children in the United States decreased by 25% in the 2000s, and mean length of stay decreased by 1 day. The cause of the decrease is multifactorial but could represent changing practice patterns in the United States. Of the patients 30% had a potential complication during hospitalization after augmentation cystoplasty. Older age and bladder exstrophy-epispadias complex diagnosis were associated with greater length of stay and increased odds of having any complication.
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