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Evaluating the safety of outpatient pediatric pyeloplasty: Insights from a national surgical database
Sri Saran Manivasagam1, Jennifer A Kane1, Ross M Decter1
1Department of Urology, Penn State Milton S. Hershey Medical Center, 500 University Dr, Hershey, PA, 17033, USA.
Insights
Outpatient pediatric pyeloplasty is safe and effective, with similar or better outcomes than inpatient care. This approach may improve access to care, though racial disparities require further study.
Area of Science:
- Pediatric Urology
- Surgical Outcomes
- Health Services Research
Background:
- Ureteropelvic junction obstruction (UPJO) is commonly treated with pyeloplasty.
- Minimally invasive techniques and outpatient care are growing trends in pediatric surgery.
- Limited data compare inpatient vs. outpatient pediatric pyeloplasty outcomes.
Purpose of the Study:
- To evaluate the safety and short-term outcomes of outpatient versus inpatient pediatric pyeloplasty.
- To identify predictors of outpatient surgery and adverse outcomes.
Main Methods:
- Analysis of 4828 pediatric pyeloplasty cases from the ACS NSQIP-Pediatric database (2021-2023).
- Stratification of patients by surgical setting (inpatient vs. outpatient).
- Comparison of 30-day postoperative complications, readmissions, and reoperations using logistic regression.
Main Results:
- Outpatient procedures were more common in older children and utilized minimally invasive techniques.
- No significant difference in 30-day infectious complications between settings.
- Inpatient cases showed higher pyeloplasty-specific readmission (4.2% vs. 2.8%) and reoperation (2.6% vs. 1.1%) rates.
- Surgical setting was not associated with adverse postoperative outcomes; White children were more likely to receive outpatient surgery.
Conclusions:
- Outpatient pediatric pyeloplasty is a safe and effective alternative to inpatient care.
- Findings support broader implementation of outpatient pathways in pediatric urology.
- Observed racial disparities in outpatient surgery access warrant further investigation.
Background:
A pyeloplasty is commonly performed to correct a physiologically significant ureteropelvic junction obstruction (UPJO). While minimally invasive techniques and outpatient surgical care are increasingly adopted, limited data exist comparing outcomes between inpatient and outpatient pediatric pyeloplasty. This study evaluates the safety and short-term outcomes of outpatient versus inpatient pyeloplasty in children.
Methods:
We analyzed pediatric pyeloplasty cases from the ACS NSQIP-Pediatric database between 2021 and 2023. Patients were stratified by surgical setting (inpatient vs. outpatient), and outcomes were compared. Primary endpoints included 30-day postoperative complications, readmissions, and reoperations. Logistic regression identified predictors of outpatient surgery and adverse outcomes.
Results:
The database recorded 4828 children undergoing pyeloplasty; 38 % were outpatient procedures and 62 % were inpatient. Outpatient procedures were more likely to be minimally invasive and performed in older children. No significant differences were observed in overall 30-day infectious complications. However, inpatient cases had higher rates of pyeloplasty-specific readmissions (4.2 % vs. 2.8 %, p = 0.043) and reoperations (2.6 % vs. 1.1 %, p < 0.001). The median inpatient length of stay was 1.52 days. On logistic regression for post-operative outcomes, the clinical setting (i.e. outpatient or inpatient) was not found to be associated with adverse post-operative outcomes. Logistic regression revealed racial disparities, with White children more likely to undergo outpatient surgery.
Conclusions:
Outpatient pediatric pyeloplasty is a safe and effective alternative to inpatient care, with comparable or better short-term outcomes. The brief inpatient stay suggests that some of these patients may be treated on an outpatient basis. The racial disparities observed in access to outpatient surgery warrant further investigation. These findings support broader implementation of outpatient pathways in pediatric urology.
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