Short-term postoperative outcomes of open and minimally invasive pyeloplasty: evidence from a NSQIP database

Ureteropelvic junction obstruction (UPJO) impairs urinary drainage and can cause hydronephrosis, infection, and renal dysfunction. Pyeloplasty is the gold-standard treatment and has evolved from open (OP) to minimally invasive (MIP) techniques. However, contemporary national data in adults remain limited. This study compares 30-day postoperative outcomes between OP and MIP using the American College of Surgeons National Surgical Quality Improvement Program (2017-2023).

Adults undergoing pyeloplasty were identified from the American College of Surgeons National Surgical Quality Improvement Program database (2017-2023) using CPT codes for minimally invasive pyeloplasty (MIP) (50544), simple open pyeloplasty (OP) (50400), and complex OP (50405). Demographic, perioperative, and postoperative outcomes were analyzed. The primary endpoint was 30-day postoperative complications; secondary endpoints included mortality, operative time, length of stay (LOS), readmission, and reoperation. Multivariable logistic and linear regression models were used to evaluate associations between surgical approach and outcomes, adjusting for baseline patient characteristics and procedural complexity.

A total of 2,712 patients were included, of whom 2,500 (92.2%) underwent MIP and 212 (7.8%) underwent OP. Patients undergoing MIP had a lower mean body mass index compared with OP (27.6 vs. 28.7 kg/m²; p = 0.03). Overall, 7.1% of patients experienced at least one postoperative complication, 4.5% were readmitted, and 2.2% required reoperation within 30 days. After multivariable adjustment, surgical approach was not independently associated with overall complication rates; however, OP was associated with a longer LOS and higher rates of postoperative infectious complications, including sepsis, compared with MIP.

In this national NSQIP cohort, MIP was associated with comparable overall postoperative complication rates and shorter length of stay compared with OP. While infectious complications were more frequent following OP, surgical approach was not independently associated with overall morbidity after multivariable adjustment. These findings support the safety of MIP in appropriately selected patients.