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Children with spinal abnormalities have an increased health burden from upper tract urolithiasis
Puneeta Ramachandra1, Kerrin L Palazzi2, Nicholas M Holmes3
1Division of Pediatric Urology, Children's Hospital Central California, Madera, CA.
Insights
Children with spinal abnormalities, including spinal curvature and spinal dysraphism, face significantly higher rates of upper tract urolithiasis. This condition leads to more procedures and increased healthcare costs, highlighting a substantial health burden.
Area of Science:
- Pediatric Urology
- Epidemiology
- Health Services Research
Background:
- Children with spinal abnormalities, such as spinal dysraphism and spinal curvature, are at increased risk for urolithiasis due to factors like immobility, bacteriuria, and urinary stasis.
- Existing literature lacks comprehensive epidemiologic data on stone disease in pediatric populations with spinal dysraphism.
- Spinal curvature may contribute to hypercalciuria from immobility, but its direct impact on urolithiasis rates is not well-established.
Purpose of the Study:
- To investigate the epidemiology and healthcare burden of upper tract urolithiasis in children with spinal abnormalities.
- To compare the prevalence, procedural rates, and associated costs of urolithiasis in children with and without spinal abnormalities.
Main Methods:
- Utilized the Pediatric Health Information Systems database for an 8-year period, including inpatient, emergency room, and ambulatory surgery visits.
- Identified pediatric patients with upper tract urolithiasis, spinal dysraphism, and spinal curvature using ICD-9 and CPT codes.
- Extracted data on demographics, stone prevalence, surgical interventions, and costs related to stone procedures.
Main Results:
- Prevalence of urolithiasis was significantly higher in children with spinal curvature (1.40%) and spinal dysraphism (4.03%) compared to those with normal spines (0.24%) (P<.001).
- Children with spinal abnormalities were more likely to undergo multiple stone procedures (25.7% for spinal dysraphism, 25% for spinal curvature) versus those without (13.1%).
- Healthcare costs per patient for stone procedures were substantially higher in children with spinal abnormalities.
Conclusions:
- Children with spinal curvature and spinal dysraphism experience a markedly elevated incidence of upper tract urolithiasis.
- Urolithiasis imposes a significant and chronic health burden on pediatric patients with spinal abnormalities, necessitating more interventions and incurring higher costs.
- Implementing targeted screening and preventive strategies may mitigate the impact of urolithiasis in this vulnerable population.
Objective:
To examine the epidemiology and health care burden of upper tract urolithiasis in children with spinal abnormalities using a large, national database. Children with spinal dysraphism are predisposed to urolithiasis for many reasons, including immobility, bacteriuria, and urinary stasis. No large epidemiologic studies exist regarding stones in this specific group. Isolated spinal curvature may lead to hypercalciuria from immobility; however, urolithiasis rates are unknown.
Methods:
We extracted data from the Pediatric Health Information Systems database over an 8-year period. Hospitals reporting inpatient visits, emergency room visits, and ambulatory surgery visits were included. Using International Classification of Diseases, Ninth Revision codes and Current Procedural Terminology codes, we identified children with upper tract urolithiasis, spinal dysraphism, and spinal curvature. Data regarding demographics, prevalence, surgical procedures, costs related to stone procedures were extracted.
Results:
A total of 11,987 patients had urolithiasis. Prevalence of stones in patients with normal spines was 0.24% compared with 1.40% and 4.03% among children with spinal curvature and spinal dysraphism, respectively (P<.001). Children with spinal curvature and spinal dysraphism were more likely to have multiple procedures for stones than those without spinal abnormalities (25% vs 25.7% vs 13.1%, P<.001). Costs per patient were significantly higher for children with spinal abnormalities compared with those with normal spines.
Conclusion:
Children with spinal curvature and spinal dysraphism have a much greater rate of upper tract urolithiasis, resulting in more procedures and related costs. Urolithiasis represents a significant, chronic health burden for children with spinal abnormalities. Screening and preventive care may reduce the impact of urolithiasis in these patients.
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