Hospital Surgical Volume and Associated Postoperative Complications of Pediatric Urological Surgery in the United States

Wang, Hsin-Hsiao S.; Tejwani, Rohit; Zhang, JJ H.; Wiener, John S.; Routh, Jonathan C.

doi:10.1016/j.juro.2015.01.096

Cited by 34 publications

(15 citation statements)

References 27 publications

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“…5 In patients with SB, UTI is the most common complaint in the emergency room setting. 6 Patients with SCI average 2.5 symptomatic UTIs per year, with similar findings in other NGB populations. 7 With the increased frequency and severity of infection, there is higher risk of morbidity and mortality secondary to urosepsis and end-stage renal disease relative to the general population.…”

Section: Epidemiologysupporting

confidence: 74%

Urinary Tract Infection and Neurogenic Bladder

McKibben

Seed

Ross

et al. 2015

Urologic Clinics of North America

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Section: Epidemiologysupporting

confidence: 74%

Urinary Tract Infection and Neurogenic Bladder

McKibben

Seed

Ross

et al. 2015

Urologic Clinics of North America

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“…We selected all pediatric patients (<18 years old) between 1998 and 2012 undergoing procedures which could reasonably be performed open or with MIS and defined this as the “entire cohort.” Procedures were defined by ICD-9-CM code (see Appendix 1 for codes and procedures); codes were previously validated at our institution to assure their accuracy [16,17]. We defined MIS procedures as those with a concurrent ICD-9-CM procedure code for laparoscopic/robotic assistance (54.51, 54.21, and/or 17.4x) [18–21].…”

Section: Methodsmentioning

confidence: 99%

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

Tejwani

Young

Wang

et al. 2017

Journal of Pediatric Urology

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Summary 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 postoperative 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 (Figure). 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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“…2,3,[7][8][9][10] The use of national inpatient databases to examine variation in pediatric costs and hospital resource use, as well as associations between hospitalbased factors and health outcomes, has been encouraged. 3,11,12 In this study, we evaluated pediatric inpatient care volume and cost trends between 2000 and 2009 at both CHs and NCHs using the nationally representative Kids' Inpatient Database (KID). Our objectives were to estimate the scope of the national growth in inpatient discharge volume and hospital costs, explore the factors responsible for this growth, and identify how these estimates vary on the basis of hospital type.…”

mentioning

confidence: 99%

Pediatric Inpatient-Status Volume and Cost at Children’s and Nonchildren’s Hospitals in the United States: 2000–2009

Short

Sarda²,

Travers

et al. 2018

Hospital Pediatrics

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A B S T R A C TOBJECTIVES: The evolving role of children's hospitals (CHs) in the setting of rising health care costs has not been fully explored. We compared pediatric inpatient discharge volumes and costs by hospital type and examined the impact of care complexity and hospital-level factors on costs.METHODS: A retrospective, cross-sectional study of care between 2000 and 2009 was performed by using the Kids' Inpatient Database. Weighted discharge data were used to generate national estimates for a comparison of inpatient volume, cost, and complexity at CHs and nonchildren's hospitals (NCHs). Linear regression was used to assess how complexity, payer mix, and hospital-level characteristics affected inflation-adjusted costs. RESULTS:Between 2000 and 2009, the number of discharges per 1000 children increased from 6.3 to 7.7 at CHs and dropped from 55.4 to 53.3 at NCHs. The proportion of discharges at CHs grew by 6.8% between 2006 and 2009 alone. In 2009, CHs were responsible for 12.6% (95% confidence interval: 10.4%-14.9%) of pediatric discharges and 14.7% of major therapeutic procedures, yet they accounted for 23.0% of inpatient costs. Costs per discharge were significantly higher at CHs than at NCHs for all years (P , .001); however, the increase in costs seen over time was not significant. Care complexity increased during the study period at both CHs and NCH, but it could not be used to fully account for the difference in costs.CONCLUSIONS: National trends reveal a small rise in both the proportion of inpatient discharges and the hospital costs at CHs, with costs being significantly higher at CHs than at NCHs. Research into factors influencing costs and the role of CHs is needed to inform policy and contain costs.

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Hospital Surgical Volume and Associated Postoperative Complications of Pediatric Urological Surgery in the United States

Cited by 34 publications

References 27 publications

Urinary Tract Infection and Neurogenic Bladder

Urinary Tract Infection and Neurogenic Bladder

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

Pediatric Inpatient-Status Volume and Cost at Children’s and Nonchildren’s Hospitals in the United States: 2000–2009

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