Is Delayed Primary Bladder Exstrophy Closure the New Norm? An Analysis of the Epic Cosmos Database

To determine the age at primary bladder exstrophy (BE) closure from 2012 to 2023. We hypothesized that the median age at primary BE closure increased from within the first week of life to more delayed closure.

A retrospective, cross-sectional analysis was performed using the Epic Cosmos database. BE patients were identified using a combination of diagnostic and procedure codes. The use and timing of pelvic osteotomies, epispadias repairs, postoperative complications, and length of stay were also noted. The primary outcome was the age at the primary BE closure. Delayed closures were defined as occurring >7 days of life. Secondary outcomes included other surgical and postsurgical aspects (eg, concomitant epispadias repair and/or osteotomy, postoperative complications, and length of stay).

One hundred forty-nine patients (77(52%) male) were identified as having a BE closure within the database. Of these, 10(7%) had an epispadias closure and 52(35%) had pelvic osteotomies coded within 2 days of their BE closure. The majority (44/52) (85%) of osteotomies occurred in patients whose BE closures were performed at >7 days of age. In 4 of the first 5 years of the study, the median age at BE closure was within 1 week of birth. Conversely, in 6 of the last 7 years of the study, the median age at BE closure was ≥2 months of life.

Data from Epic Cosmos hospitals suggest a shift from immediate postnatal to delayed primary BE closure between 2012 and 2023. Only one-third of patients underwent pelvic osteotomy synchronous with BE closure.