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Antireflux Surgery at National Surgical Quality Improvement Program-Pediatric Hospitals
Emilie K Johnson1, David J Chalmers2, Caleb P Nelson3
1Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
Insights
Open reimplant remains the most common procedure for vesicoureteral reflux, though practice patterns vary. Endoscopic injection shows fewer unplanned procedures, informing standardized surgical pathways.
Area of Science:
- Pediatric Urology
- Surgical Quality Improvement
- Health Services Research
Background:
- Vesicoureteral reflux (VUR) is a common condition in children, often treated with ureteral reimplant or endoscopic injection.
- Understanding current practice patterns and short-term outcomes is crucial for optimizing VUR treatment.
- The National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database offers a valuable resource for analyzing surgical quality.
Purpose of the Study:
- To examine contemporary practice patterns for ureteral reimplant and endoscopic injection procedures for VUR.
- To compare short-term outcomes between different VUR surgical procedures using NSQIP-P data.
- To identify patient and procedural factors associated with VUR treatment outcomes.
Main Methods:
- Procedure-specific variables were developed for antireflux surgery within the NSQIP-P database.
- Data included VUR grade, urine cultures, and 31-60-day follow-up.
- Descriptive statistics and logistic regression analyzed associations between factors and outcomes like UTIs, readmissions, and unplanned procedures.
Main Results:
- A total of 2,842 patients (median age 4 years, 76% female) underwent VUR procedures between July 2016 and June 2018.
- Open reimplant (68%) was most common, followed by endoscopic injection (25%), with significant hospital variability.
- Short-term outcomes at 30 days included ED visits (10%), readmissions (4%), UTIs (3%), and unplanned procedures (2%).
Conclusions:
- Open reimplant is the predominant VUR procedure, but its utilization varies across institutions.
- Endoscopic injection is associated with a lower rate of unplanned procedures compared to reimplant.
- These findings support the comparison of short-term complications and the development of standardized perioperative pathways for VUR surgery.
Purpose:
This study aims to examine contemporary practice patterns and compare short-term outcomes for vesicoureteral reflux procedures (ureteral reimplant/endoscopic injection) using National Surgical Quality Improvement Program-Pediatric data.
Materials And Methods:
Procedure-specific variables for antireflux surgery were developed to capture data not typically collected in National Surgical Quality Improvement Program-Pediatric (eg vesicoureteral reflux grade, urine cultures, 31-60-day followup). Descriptive statistics were performed, and logistic regression assessed associations between patient/procedural factors and outcomes (urinary tract infection, readmissions, unplanned procedures).
Results:
In total, 2,842 patients (median age 4 years; 76% female; 68% open reimplant, 6% minimally invasive reimplant, 25% endoscopic injection) had procedure-specific variables collected from July 2016 through June 2018. Among 88 hospitals, a median of 24.5 procedures/study period were performed (range 1-148); 95% performed ≥1 open reimplant, 30% ≥1 minimally invasive reimplant, and 70% ≥1 endoscopic injection, with variability by hospital. Two-thirds of patients had urine cultures sent preoperatively, and 76% were discharged on antibiotics. Outcomes at 30 days included emergency department visits (10%), readmissions (4%), urinary tract infections (3%), and unplanned procedures (2%). Over half of patients (55%) had optional 31-60-day followup, with additional outcomes (particularly urinary tract infections) noted. Patients undergoing reimplant were younger, had higher reflux grades, and more postoperative occurrences than patients undergoing endoscopic injections.
Conclusions:
Contemporary data indicate that open reimplant is still the most common antireflux procedure, but procedure distribution varies by hospital. Emergency department visits are common, but unplanned procedures are rare, particularly for endoscopic injection. These data provide basis for comparing short-term complications and developing standardized perioperative pathways for antireflux surgery.
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