Postoperative course following complex major pediatric urologic surgery: A single surgeon experience
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In brief
In brief
This retrospective study of 372 pediatric urologic procedures (251 robotic, 121 open) found that robotic approaches were associated with fewer emergency room visits and infectious complications compared to open surgery, though readmission rates were similar. Procedure characteristics rather than patient demographics predicted unplanned returns, with lower tract procedures showing higher ER visit rates.
Written by the GCMD Library team from the article.
Background/Purpose
Payers have established unplanned returns as quality measures tied to reimbursement. We sought to identify patient characteristics and surgical factors associated with unplanned returns and postoperative complications following intraabdominal pediatric urologic procedures. Only one study has emergency room visits in pediatric urology, but included only limited case complexity.
Methods
We retrospectively reviewed electronic medical records of all pediatric patients who underwent urological surgery from 2007 to 2016 by a single surgeon. Univariate and multivariate regressions were used to determine factors associated with length of stay, unplanned ER visits and readmissions.
Results
A total of 372 cases were included, of which 251 were robotic and 121 were open. Overall, the rate of ER visits was 19%, rate of readmissions was 8.7%, and rate of reoperations was 4.3%. We found that the odds of a urologic ER visit and Clavien grade II (infectious) complications were comparatively lower for robotic surgery, but not readmission. Undergoing a lower tract procedure was significantly associated with a related ER visit; however, patient insurance status was not related to unplanned returns.
Conclusions
Procedure characteristics, not patient demographics were associated with unplanned returns. Robotic approach was associated with fewer ER visits and infectious complications, indicating potential cost savings.
Levels of Evidence
Level 3 Treatment Study.