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Operative management of urachal remnants: An NSQIP based study of postoperative complications
Paul Aylward1, Kaeli Samson2, Stephen Raynor3
1University of Nebraska Medical Center, Department of Surgery, 98280 Nebraska Medical Center, Omaha, NE 68198-3280.
Insights
Urachal remnant resection in younger patients increases risks of reoperation and readmission. Delaying surgery past one year of age may improve outcomes for pediatric urachal anomalies.
Area of Science:
- Pediatric Surgery
- Urology
- Medical Management
Background:
- Urachal remnants are increasingly diagnosed in infants.
- Nonoperative management is effective, yet surgical resection is common.
- Surgical intervention carries a significant complication rate.
Purpose of the Study:
- To investigate the association between age at urachal remnant resection and complication rates.
- To evaluate the impact of age on reoperation, readmission, and length of stay.
Main Methods:
- Retrospective analysis of pediatric patients undergoing urachal remnant resection (2013-2017).
- Data sourced from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Pediatric database.
- Exclusion of emergent operations, contaminated wounds, and concurrent procedures; comparison based on outcomes.
Main Results:
- Overall complication rate was 3.3% (16/476 patients).
- Younger patients (median age 0.1 years) had higher reoperation rates compared to older patients (1.3 years; p=0.004).
- Readmission rates were higher in younger patients (median age 0.4 years) versus older patients (1.4 years; p=0.03), with a trend towards longer hospital stays.
Conclusions:
- Operative management of urachal remnants in younger children is linked to increased risks of reoperation, readmission, and prolonged hospitalization.
- Delaying surgical resection of urachal remnants until after one year of age may mitigate these risks.
- Consideration of nonoperative management is recommended for urachal anomalies.
Purpose:
The identification of urachal remnants is occurring more in infancy. Despite evidence that nonoperative management is effective, operative management remains common and has a high complication rate. We sought to determine if the complication rate after urachal resection is associated with age.
Methods:
Patients undergoing urachal remnant resection were identified from ACS NSQIP Pediatric from 2013 to 2017. Exclusion criteria included emergent operations, contaminated wounds, and any additional procedures. Patients were compared based on complication rates, need for reoperation or readmission, and length of stay.
Results:
A complication occurred in 16 of 476 patients (3.3%), 6 (1.3%) had reoperation, and 11 (2.3%) were readmitted. The median age for patients requiring reoperation was lower (0.1 years) than those not (1.3 years; p = 0.004). The median age of those readmitted was lower (0.4 years) than those not (1.4 years, p = 0.03), and a weak trend of longer length of stay in younger patients was identified (ρ = -0.16, p < 0.001).
Conclusions:
Operative management of younger patients resulted in greater risk of reoperation, readmission, and longer length of stay. Given that nonoperative management is effective, it may be of benefit to delay resection of urachal remnants to after 1 year of age.
Study Type:
Treatment study.
Level Of Evidence:
Level III.
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