A comparison of open vs laparoscopic pediatric pyeloplasty using the pediatric health information system database--do benefits of laparoscopic approach recede at younger ages?
OBJECTIVE
The potential benefits of laparoscopic pyeloplasty may recede in younger age groups. We used a multi-institutional database to address the effect of laparoscopic approach on length of stay and postoperative parenteral narcotic use in specific pediatric age groups.


METHODS
We performed a retrospective study of 5,261 children with an ICD-9 procedure code for correction of ureteropelvic junction obstruction from the Pediatric Health Information System, a database of freestanding pediatric hospitals. Discharge dates from January 1, 2002 to June 30, 2007 were included. Laparoscopic cases were identified by ICD-9 procedure codes and hospital equipment charges. We used multivariate linear regression to investigate the effect of laparoscopic approach on length of stay and parenteral narcotic use in several age categories, including infant (1 month to less than 2 years old), preschool (2 to less than 6 years), grade school (6 to less than 10 years), preadolescent (10 to less than 13 years) and adolescent (13 to less than 19 years).


RESULTS
Laparoscopic approach decreased length of stay and number of parenteral narcotic pharmacy charges in the preadolescent (p = 0.03 and p = 0.005, respectively) and adolescent (p = 0.03 and p = 0.006, respectively) groups but not in any of the younger groups.


CONCLUSIONS
Laparoscopic approach was associated with a shorter hospital stay and decreased parenteral narcotic use in patients older than 10 years. Evolving technique may reveal less morbidity in younger patients. Future comparisons to open pyeloplasty should address specific pediatric age groups and outpatient convalescence.
Tanaka
Stacy T
ST
Division of Pediatric Urology, Monroe Carell Jr. Vanderbilt Children's Hospital, Nashville, Tennessee 37232-9820, USA. stacy.tanaka@vanderbilt.edu
Grantham
John A
JA
Thomas
John C
JC
Adams
Mark C
MC
Brock
John W
JW
Pope
John C
JC
D000293:Adolescent; D000367:Age Factors; D000700:Analgesics / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007682:Kidney Pelvis / Q000503:physiopathology / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy*; D011183:Postoperative Complications / Q000453:epidemiology; D011336:Probability; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000175:diagnosis / Q000601:surgery*
D000700:Analgesics