Factors Associated With Short Term Outcomes After Pyeloplasty in the Pediatric Population

Area of Science:

• Pediatric Urology
• Surgical Outcomes Research
• Health Informatics

Background:

• Pyeloplasty is a common procedure for pediatric ureteropelvic junction obstruction.
• Understanding factors influencing post-operative outcomes is crucial for improving patient care.
• The National Surgical Quality Improvement Program Pediatrics (NSQIP-P) database offers valuable insights into surgical outcomes.

Purpose of the Study:

• To identify patient and surgical factors associated with 30-day morbidity following pediatric pyeloplasty.
• To analyze complication rates and types after open and laparoscopic pyeloplasty.
• To stratify risks based on patient demographics and surgical characteristics.

Main Methods:

• Retrospective cohort study utilizing the NSQIP-P database (2012-2021).
• Inclusion of pediatric patients undergoing open or laparoscopic pyeloplasty.
• Evaluation of patient factors (age, prematurity, weight, ASA classification) and surgical factors (operative time, pre-op labs, steroid use).
• Complication assessment using Clavien-Dindo (CD) classification.

Main Results:

• 8221 patients were analyzed; 6.4% experienced 30-day readmissions.
• Urinary Tract Infection (UTI) was the most frequent complication (2.8%).
• History of prematurity (HOP) and younger age (<23 months) correlated with Clavien-Dindo I-II complications.
• Low weight was associated with higher-grade complications (CD III-V).
• HOP significantly increased UTI incidence (OR 8.09).

Conclusions:

• Post-pyeloplasty complications are infrequent, with UTIs being the primary concern.
• History of prematurity and low weight at surgery are significant risk factors for pyeloplasty complications.
• Risk stratification incorporating these factors can aid in optimizing surgical planning and patient management.