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Minimally invasive versus open pyeloplasty in children: the differential effect of procedure volume on operative outcomes
Briony Varda*, Boston, MA, Jesse D. Sammon, Detroit, MI, Shyam Sukumar, Minneapolis, MN, Courtney K. Rowe, Boston, MA, Akshay Sood, Detroit, MI, Marianne Schmid, Hamburg, Germany, Orchidee Djahangirian, Montreal, Canada, Ramdev Konijeti, Boston, MA, Khurshid R. Ghani, Ann Arbor, MI, Nedim Ruhotina, Boston, MA, Wooju Jeong, Detroit, MI, Pierre Karakiewicz, Maxine Sun, Montreal, Canada, Adam S. Kibel, Boston, MA, Kirsten JanosekéAlbright, Detroit, MI, Quoc-Dien Trinh, Boston, MA

INTRODUCTION AND OBJECTIVES: Despite the absence of high-level evidence of its superiority, minimally invasive pyeloplasty (MIP) is being increasingly utilized for the management of pediatric ureteropelvic junction obstruction (UPJO). While recent reports indicate equivalence with open pyeloplasty (OP) in terms of certain perioperative endpoints, these reports do not elucidate and account for volume-outcome dynamics.

METHODS: Within the Nationwide Inpatient Sample, a weighted-estimate of 6,006 pediatric patients (<18 years; 2008- 2010) with UPJO underwent either OP or MIP. National trends in utilization and comparative effectiveness outcomes were examined in terms of intra-operative complications, post-operative complications, prolonged length of stay and excessive hospital charges. Hospitals were stratified into volume quartiles. Specifically, the volume-outcome dynamics of the highest and lowest volume quartiles of both approaches were examined with binary logistic regression models.

RESULTS: MIP accounted for 17.2% of cases during the study years. On individual multivariate models (relative to highvolume OP patients, HVOP) high-volume MIP (HVMIP), low-volume OP (LVOP), low-volume MIP (LVMIP) patients had significantly higher risks of developing postoperative complications, genitourinary complications and excessive hospital charges (Table 1). Regardless of hospital volume, MIP patients experienced shorter stays.

CONCLUSIONS: While there has been a substantial uptick in the utilization of MIP, high-volume hospitals performing OP have the best perioperative outcomes in terms of post-operative complications, genitourinary complications and overall hospital charges. However, HV hospitals performing MIP have better outcomes compared to LV hospitals performing OP (Table 2). Shorter hospital stays is the one mitigating factor of MIP.

Source of Funding: none

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