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Updated: Jun 12, 2025
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Factors and outcomes leading to postoperative emergency department visits after ureteroneocystostomy
Young Son1, Mark Quiring2, Scott Serpico3
1Department of Urology, Jefferson New Jersey Urology, Stratford, NJ 08084, United States.
Insights
Ureteroneocystostomy (UNC) for pediatric vesicoureteral reflux (VUR) can lead to emergency department (ED) visits, often due to infections or catheter issues. Identifying risk factors like postoperative UTIs and unplanned catheterizations can help prevent these readmissions.
Area of Science:
- Pediatric Urology
- Surgical Outcomes Research
- Vesicoureteral Reflux Management
Background:
- Ureteroneocystostomy (UNC) is the standard treatment for pediatric vesicoureteral reflux (VUR).
- Despite UNC's efficacy, high rates of 30-day and 90-day readmissions and emergency department (ED) visits are observed.
- Urinary tract infections (UTIs) and catheter complications are common reasons for post-procedural ED visits.
Purpose of the Study:
- To identify modifiable patient characteristics at discharge that predict unplanned ED visits after UNC.
- To improve patient outcomes and reduce healthcare utilization following pediatric UNC procedures.
Main Methods:
- Analysis of the 2020 American College of Surgeons National Surgical Quality Improvement Program Pediatric database.
- Inclusion of 1495 pediatric patients who underwent UNC for VUR.
- Comparison of patients with (n=164) and without (n=1331) 30-day postoperative ED visits using logistic regression.
Main Results:
- 11.0% of patients visited the ED within 30 days post-UNC.
- Independent risk factors for ED visits included postoperative UTI, superficial surgical site infection, unplanned procedures, unplanned urinary catheterization, and prematurity.
- Patients with ED visits were more likely to have longer operative times, surgical site infections, sepsis, prior readmissions, and blood transfusions.
Conclusions:
- Postoperative infections are a primary driver of ED visits after UNC.
- Vigilance before discharge is crucial to prevent unplanned ED visits.
- Addressing modifiable risk factors like infection and catheter management can improve outcomes.
Background:
Ureteroneocystostomy (UNC) is considered the gold standard for pediatric vesicoureteral reflux (VUR) treatment. While UNC lowers the likelihood of needing additional VUR procedures within 12 months, patients also have high 30-day and 90-day readmission rates and emergency department (ED) visits. The most common causes of an ED visit following any urologic procedure are urinary tract infections (UTIs) and catheter/drain concerns. Prior studies are limited in identifying predisposing factors to help mitigate complications of UNC and improve patient outcomes.
Aim:
To identify modifiable characteristics at the time of discharge after UNC that predict subsequent unplanned ED visits.
Methods:
The 2020 American College of Surgeons National Surgical Quality Improvement Program Pediatric data was analyzed for patients undergoing UNC for VUR. A total of 1742 patients were evaluated, with 1495 meeting inclusion criteria. Patients with an ED visit within 30 days following an anti-reflux procedure (n = 164) were compared to those who did not return to the ED (n = 1331). Basic statistics and logistic regression analysis were performed to find predictive factors associated with postoperative ED visits after UNC.
Results:
Among the 1495 patients, 11.0% visited the ED within the 30-day postoperative period. Patients who returned to the ED visit following UNC were more likely to have had a longer mean operative time, surgical site infection, postoperative UTI, postoperative sepsis, history of prior readmission, unplanned reoperation, blood transfusion, or unplanned urinary catheter placement. Multivariate analysis revealed postoperative UTI (P < 0.001), superficial surgical site infection (P = 0.022), unplanned procedure (P < 0.001), unplanned urinary catheter (P < 0.001), and prematurity (35-36 weeks gestation) (P = 0.004) as independent risk factors for postoperative ED visits.
Conclusion:
Utmost caution is needed prior to discharge after UNC to forestall a return to the ED. Postoperative infection remains a primary risk for ED visits in the acute postoperative period.
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