Abstract Book - 26th ESPU Congress, Joint Meeting with ICCS + SPU + AAP/SOU + AAPU + SFU

11:38 - 11:41

S15-5

(PP)

★

PEDIATRIC SUB-SPECIALIZATION AND INPATIENT COMPLICATION RATES FOR

PEDIATRIC UROLOGY PROCEDURES

Jonathan ROUTH

, Rohit TEJWANI

, Hsin-Hsiao WANG

, Nathaniel GREENE

, Steven WOLF

and John WIENER

1) Duke University School of Medicine, Urology, 27710, USA - 2) Duke University School of Medicine, Anesthesiology,

Durham, USA - 3) Duke University School of Medicine, Biostatistics & Bioinformatics, Durham, USA

PURPOSE

Improved surgical outcomes have been associated with increased pediatric case volumes and training for pediatric

general surgery. However, the impact of pediatric urology sub-specialization and surgical volume on inpatient urologic

surgical complication rates is unknown. We queried a nationwide database to determine if surgeon sub-specialization in

pediatric urology was associated with improved complication rates.

PATIENTS AND METHODS

We retrospectively reviewed the Nationwide Inpatient Sample (1998-2009) for pediatric (≤ 18 years) admissions. We

used ICD-9-CM codes to identify urologic surgeries and National Surgical Quality Improvement Program (NSQIP) in-

hospital post-operative complications. We calculated a Pediatric Proportion Index (PPI) as the ratio of children to all

patients operated on by each individual urologist. We performed a weighted multivariate analysis adjusting for clusters,

stratums, age, gender, and race to test for an association between PPI and the probability of a surgical complication.

RESULTS

Our final cohort included 71,480 weighted inpatient admissions. Pediatric sub-specialty admissions were younger than

non-sub-specialty admissions (4.6 vs. 6.4y, p<0.001). Groups did not differ by race (p=0.9) or gender (p=0.09).

Mortality rates were slightly lower for pediatric sub-specialized urologists than non-sub-specialists (0.9 vs. 0.4%,

p=0.009). Likewise, non-subspecialized urologists had a significantly higher complication rate than pediatric urologists

(13 vs. 11%, p=0.02). After adjusting for other confounders, PPI, as a continuous variable, was significantly associated

with a decreased probability of a postoperative complication (OR 0.7, 95% CI 0.59-0.98, p=0.03).

CONCLUSIONS

Increased pediatric sub-specialization among urologists is associated with a decreased risk of surgical complications in

children undergoing inpatient urologic procedures.