小児パイロプラステｨの安全性評価：全国外科データベースからの洞察

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.

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.

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.

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.