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Risk factors for repeat surgical intervention in pediatric nephrolithiasis: A Pediatric Health Information System
Jonathan S Ellison1, Margarett Shnorhavorian1, Assaf Oron1
1Pediatric Urology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.
Insights
Shock wave lithotripsy (SWL) has a higher risk of repeat interventions for pediatric upper urinary tract calculi (UUTC). Stenting and patient factors also predict retreatment needs in children with kidney stones.
Area of Science:
- Pediatric Urology
- Nephrolithiasis Management
- Surgical Outcomes Research
Background:
- Pediatric upper urinary tract calculi (UUTC) management aims to minimize repeat interventions.
- Staged procedures, planned or unplanned, are sometimes necessary for UUTC.
- Predictors of repeat intervention for pediatric UUTC require assessment.
Purpose of the Study:
- To assess predictors of repeat intervention for pediatric UUTC.
- To identify patient and procedural variables associated with retreatment.
- To compare risks of retreatment between different surgical modalities.
Main Methods:
- Utilized the Pediatric Health Information System (PHIS) dataset.
- Analyzed children with UUTC undergoing shock wave lithotripsy (SWL) or ureteroscopy (URS) from 2010-2015.
- Employed multivariable logistic regression to identify risk factors for retreatment within 90 days.
Main Results:
- SWL was associated with a 2.6-fold higher risk of repeat stone-related interventions compared to URS.
- Independent risk factors for retreatment included SWL, stenting, chronic comorbidities, renal calculi, and younger age (<5 years).
- Intra-operative ureteral stent placement was a strong predictor of retreatment.
Conclusions:
- SWL increases the risk of repeat interventions for pediatric UUTC.
- Patient factors and intra-operative stenting are significant predictors of retreatment.
- Further prospective studies are needed to evaluate comparative effectiveness and optimize single-stage treatment success.
Introduction:
Successful surgical therapy for pediatric upper urinary tract calculi (UUTC) minimizes the need for repeat surgical interventions. However, staged procedures, whether planned or unplanned, are sometimes necessary. We assessed predictors of repeat intervention for children with UUTC using a nationwide administrative dataset.
Methods:
Using the Pediatric Health Information System (PHIS) dataset, we assessed children with UUTC undergoing shock wave lithotripsy (SWL) or ureteroscopy (URS) for an index stone from January 2010 to June 2015. Primary outcome was additional treatment for nephrolithiasis within 90 days. Patient and procedural variables were assessed as potential risks for retreatment. Multivariable logistic regression models were used to compare the risk of retreatment adjusting for potential confounding factors.
Results:
A total of 2788 patients undergoing URS (2,216, 79.5%) and SWL (572, 20.5%) were identified. SWL, stenting at the index operation without pre-index stenting, chronic comorbidities, renal calculi, and age <5 years were independent risk factors for retreatment. Use of ureteral stenting, most commonly employed in URS, was also a strong predictor of retreatment. Odds for reintervention, adjusted by multivariate modeling, are shown in the Figure.
Conclusions:
Adjusting for measured confounders, SWL is associated with a 2.6-fold higher risk of repeat stone-related interventions. Additional patient-related factors also increase likelihood of retreatment. Intra-operative stent placement is a strong predictor of retreatment, perhaps serving as a marker for complex cases or planned staged procedures. Prospective studies are needed to assess comparative effectiveness of SWL and URS and improve mono-therapeutic success for children with UUTC.
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