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S20-7
(P)
OPEN VERSUS MINIMALLY-INVASIVE URETERONEOCYSTOSTOMY: A NATIONAL
POPULATION-LEVEL DATABASE ANALYSIS
Hsin-Hsiao WANG
1
, Rohit TEJWANI
1
, Glenn CANNON
2
, Patricio GARGOLLO
3
and Jonathan ROUTH
1
1) Duke University Medical Center, Division of Urologic Surgery, Durham, USA - 2) CHILDREN'S HOSPITAL OF
PITTSBURGH, DIVISION OF PEDIATRIC UROLOGY, Pittsburg, USA - 3) TEXAS CHILDREN'S HOSPITAL, DIVISION OF
UROLOGY, Houston, USA
PURPOSE
Open ureteroneocystotomy (UNC) is the gold standard for surgical correction of vesicoureteral reflux (VUR). Beyond
single-center reports, there is little published data on minimally-invasive (MIS) UNC. Our objective was to compare
post-operative outcomes of open and MIS UNC using national, population-level data.
MATERIAL AND METHODS
We reviewed the 1998-2012 Nationwide Inpatient Sample to identify pediatric (≤ 18y) VUR patients who underwent
either open or MIS UNC. Demographics, National Surgical Quality Improvement Program (NSQIP) complications, length
of stay (LOS), and cost data were extracted. Statistical analysis was performed using weighted, hierarchical multivariate
logistic regression (complications) and negative binomial regression (LOS, cost).
RESULTS
We identified 780 MIS and 75,976 open UNC admissions. Compared with patients undergoing open UNC, patients who
underwent MIS UNC were likely to be older (6.2 v. 4.8 years, p<0.001), publically insured (43 v. 26%, p<0.001),
treated in recent years (90 v. 46% after 2005, p<0.001). MIS admissions were associated with a significantly shorter
length of stay (1.0 v. 1.8 days, p<0.001) and higher cost ($9,230 v. $6,304, p=0.002).
After adjusting for patient-level confounders (age, gender, insurance, treatment year, and comorbidity), and hospital-
level factors (region, bedsize, and teaching status), MIS UNC was associated with a significantly higher rate of
postoperative urinary complications such as UTIs, urinary retention, and renal injury (OR=3.1, p=0.02), shorter LOS
(RR=0.8, p=0.02), and higher cost (RR=1.4, p=0.008).
CONCLUSIONS
Compared to open surgery, MIS UNC was associated with shorter LOS but significantly higher costs and higher urinary
complication rates.