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Open versus minimally invasive surgical approaches in pediatric urology: Trends in utilization and complications.

Publication ,  Journal Article
Tejwani, R; Young, BJ; Wang, H-HS; Wolf, S; Purves, JT; Wiener, JS; Routh, JC
Published in: J Pediatr Urol
June 2017

OBJECTIVE: Minimally invasive surgery (MIS) techniques are anecdotally reported to be increasingly used, but little objective data supports this. Our objective was to assess trends in MIS utilization across various procedures in pediatric urology and to compare postoperative complication rates between MIS and open procedures. METHODS: We analyzed the 1998-2012 Nationwide Inpatient Sample. We identified children (<18 years old) undergoing open and MIS inpatient procedures and any in-hospital post-operative complications that occurred during that postoperative hospitalization. We utilized propensity score matching and multivariable logistic regression to adjust for confounding factors. RESULTS: We identified 163,838 weighted encounters in the "overall cohort," 70,273 of which were at centers performing more than five MIS procedures over the years studied. Use of MIS techniques increased significantly over time for several procedures, most prominently for nephrectomy (Fig.). The overall rate of complications was lower in patients undergoing MIS compared with open surgery (6% vs. 11%, p < 0.001). Specialized centers had a significantly lower overall rate of complications than unspecialized centers (9% vs. 12%, p < 0.001). Within specialized centers, MIS had lower complication rates than open procedures (7% vs. 9%, p < 0.001); this finding was consistent even after adjusting for other factors (OR 0.71, p = 0.02). DISCUSSION: Limitations include that these data may not be generalizable to encounters not in the sample pool. As a large, retrospective, administrative database, NIS may be affected by miscoding bias - rendering our analysis sensitive to the accuracy of procedure coding in NIS. Although the accuracy level of NIS is high for an administrative database, it is possible at least some portion of our cohort may be incorrectly coded. Further, the NSQIP complications we identified may represent associated comorbidities and not true postoperative complications, as NIS does not provide temporal relationships between different diagnosis codes. Despite these limitations, we note that the NIS database is rigorously monitored and audited for coding accuracy and, therefore, represents a reasonably reliable panorama of the characteristics of an inpatient surgical cohort. However, it is important to note that the choice of operative modality is, undoubtedly, multifactorial and patient/setting-specific. CONCLUSIONS: There is increasing use of MIS for pediatric urology procedures, although utilization rates vary among procedures. MIS was associated with a lower postoperative complication rate than for open procedures. Higher-volume MIS centers have a lower complication rate than lower-volume centers.

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Published In

J Pediatr Urol

DOI

EISSN

1873-4898

Publication Date

June 2017

Volume

13

Issue

3

Start / End Page

283.e1 / 283.e9

Location

England

Related Subject Headings

  • Urology & Nephrology
  • Urologic Surgical Procedures
  • United States
  • Retrospective Studies
  • Postoperative Complications
  • Minimally Invasive Surgical Procedures
  • Male
  • Humans
  • Hospitalization
  • Female
 

Citation

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Tejwani, R., Young, B. J., Wang, H.-H., Wolf, S., Purves, J. T., Wiener, J. S., & Routh, J. C. (2017). Open versus minimally invasive surgical approaches in pediatric urology: Trends in utilization and complications. J Pediatr Urol, 13(3), 283.e1-283.e9. https://doi.org/10.1016/j.jpurol.2017.01.013
Tejwani, Rohit, Brian J. Young, Hsin-Hsiao S. Wang, Steven Wolf, J Todd Purves, John S. Wiener, and Jonathan C. Routh. “Open versus minimally invasive surgical approaches in pediatric urology: Trends in utilization and complications.J Pediatr Urol 13, no. 3 (June 2017): 283.e1-283.e9. https://doi.org/10.1016/j.jpurol.2017.01.013.
Tejwani R, Young BJ, Wang H-HS, Wolf S, Purves JT, Wiener JS, et al. Open versus minimally invasive surgical approaches in pediatric urology: Trends in utilization and complications. J Pediatr Urol. 2017 Jun;13(3):283.e1-283.e9.
Tejwani, Rohit, et al. “Open versus minimally invasive surgical approaches in pediatric urology: Trends in utilization and complications.J Pediatr Urol, vol. 13, no. 3, June 2017, pp. 283.e1-283.e9. Pubmed, doi:10.1016/j.jpurol.2017.01.013.
Tejwani R, Young BJ, Wang H-HS, Wolf S, Purves JT, Wiener JS, Routh JC. Open versus minimally invasive surgical approaches in pediatric urology: Trends in utilization and complications. J Pediatr Urol. 2017 Jun;13(3):283.e1-283.e9.
Journal cover image

Published In

J Pediatr Urol

DOI

EISSN

1873-4898

Publication Date

June 2017

Volume

13

Issue

3

Start / End Page

283.e1 / 283.e9

Location

England

Related Subject Headings

  • Urology & Nephrology
  • Urologic Surgical Procedures
  • United States
  • Retrospective Studies
  • Postoperative Complications
  • Minimally Invasive Surgical Procedures
  • Male
  • Humans
  • Hospitalization
  • Female