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Updated: Apr 11, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
30-Day morbidity after augmentation enterocystoplasty and appendicovesicostomy: A NSQIP pediatric analysis
Erin R McNamara1, Michael P Kurtz2, Anthony J Schaeffer2
1Department of Urology, Boston Children's Hospital, Harvard Medical School, Boston, USA; Harvard-wide Pediatric Health Services Research Fellowship, Boston, MA, USA.
Insights
Nearly 30% of pediatric patients undergoing augmentation enterocystoplasty and appendicovesicostomy experienced a 30-day event. Longer operative times, more concurrent procedures, and higher surgical risk scores increased the likelihood of complications, readmissions, or reoperations.
Area of Science:
- Pediatric Urology
- Surgical Outcomes Research
Background:
- Augmentation enterocystoplasty and appendicovesicostomy are complex pediatric urologic procedures.
- Limited data exists on short-term postoperative outcomes due to small case numbers and lack of prospective data.
- This study reports 30-day outcomes from the first national prospective cohort.
Purpose of the Study:
- Determine 30-day complication, readmission, and reoperation rates after these procedures in a large pediatric national sample.
- Explore associations between preoperative/intraoperative factors and 30-day adverse events.
- Utilize the American College of Surgeons National Surgical Quality Improvement Program Pediatric (ACS-NSQIPP) database for comprehensive analysis.
Main Methods:
- Utilized the 2012-2013 ACS-NSQIPP database for patients undergoing augmentation enterocystoplasty and/or appendicovesicostomy.
- Classified surgical risk using a validated pediatric-specific comorbidity score.
- Analyzed prospectively collected data on intraoperative characteristics and 30-day postoperative events using multivariate logistic regression.
Main Results:
- Included 461 pediatric patients: 245 appendicovesicostomy, 97 augmentation enterocystoplasty, 119 both.
- Documented 110 complications in 87 patients; urinary tract infection was most common.
- A composite of any 30-day event (complication, readmission, reoperation) occurred in 27.8% of patients.
Conclusions:
- The ACS-NSQIPP database is a valuable tool for examining short-term outcomes in complex pediatric urologic surgery.
- Longer operative time, increased number of concurrent procedures, and higher surgical risk score were associated with increased 30-day adverse events.
- These findings aid in patient/family counseling and improving surgical outcomes through practice standardization and transparent reporting.
Introduction:
Augmentation enterocystoplasty and appendicovesicostomy are complex pediatric urologic procedures. Although there is literature identifying long-term outcomes in these patients, the reporting of short-term postoperative outcomes has been limited by small numbers of cases and lack of prospective data collection. Here we report 30-day outcomes from the first nationally based, prospectively assembled cohort of pediatric patients undergoing these procedures.
Objective:
To determine 30-day complication, readmission and reoperation after augmentation enterocystoplasty and appendicovesicostomy in a large national sample of pediatric patients, and to explore the association between preoperative and intraoperative characteristics and occurrence of any 30-day event.
Study Design:
We queried the 2012 and 2013 American College of Surgeons National Surgical Quality Improvement Program Pediatric database (ACS-NSQIPP) for all patients undergoing augmentation enterocystoplasty and/or appendicovesicostomy. Surgical risk score was classified on a linear scale using a validated pediatric-specific comorbidity score. Intraoperative characteristics and postoperative 30-day events were reported from prospectively collected data. A composite measure of complication, readmission and/or reoperation was used as primary outcome for the multivariate logistic regression.
Results:
There were 461 patients included in the analysis: 245 had appendicovesicostomy, 97 had augmentation enterocystoplasty and 119 had both procedures. There were a total of 110 NSQIP complications seen in 87 patients. The most common complication was urinary tract infection (see Table for 30-day outcomes by patient). The composite measure of any 30-day event was seen in 27.8% of the cohort and this was associated with longer operative time, increased number of procedures done at time of primary surgical procedure and higher surgical risk score.
Discussion:
The ACS-NSQIPP provides a tool to examine short-term outcomes for these complex urologic procedures that has not been possible before. Although ACS-NSQIP has been used extensively in the adult surgical literature to identify rates of complications, and to determine predictors of readmission and adverse events, its use in pediatric surgery is new. As in the adult literature, the goal is for standardization of practice and transparency in reporting outcomes that may lead to reduction in morbidity and mortality.
Conclusion:
In this cohort, any 30-day event is seen in almost 30% of the patients undergoing these urologic procedures. Operative time, number of concurrent procedures and higher surgical risk score all are associated with higher odds of the composite 30-day event of complication, readmission and/or reoperation. These data can be useful in counseling patients and families about expectations around surgery and in improving outcomes.
