Postoperative course following complex major pediatric urologic surgery: A single surgeon experience.
Aaron Wallace, Maria Veronica Rodriguez, Mohan S Gundeti
Author Information
Aaron Wallace: The University of Chicago, Pritzker School of Medicine. Electronic address: aaronwallace@uchicago.edu.
Maria Veronica Rodriguez: Section of Urology, University of Chicago Medicine, Comer Children's Hospital, 5841 S. Maryland Avenue, Rm. P-217, MC 7122, Chicago, IL 60637, USA.. Electronic address: mrodrigez2@surgery.bsd.uchicago.edu.
Mohan S Gundeti: Section of Urology, University of Chicago Medicine, Comer Children's Hospital, 5841 S. Maryland Avenue, Rm. P-217, MC 7122, Chicago, IL 60637, USA.. Electronic address: mgundeti@surgery.bsd.uchicago.edu.
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.
