title: Outcomes after pediatric ureteral reimplantation: a population based analysis.
abstract: OBJECTIVE
  Pediatric urology literature is often biased toward single, high volume institutions. We determined the impact of patient, surgeon and hospital characteristics on immediate outcomes for children undergoing ureteral reimplantation.
  
  
  METHODS
  We queried the University Health-System Consortium Clinical Data Base to identify a pediatric population who underwent ureteroneocystostomy between 2004 and 2009. We measured the association of the outcome variables length of stay, number of days in the intensive care unit and complication rates on the independent variables of age, gender, race, insurance status, year of surgery, and surgeon and hospital characteristics. The data were analyzed using multiple logistic, Poisson and Poisson hurdle model regression analyses incorporating random effects for surgeon and hospital.
  
  
  RESULTS
  We identified 5,668 subjects who underwent ureteroneocystostomy. Compared with patients treated by high volume providers, those treated by low volume surgeons (less than 13 cases per year) had a longer length of stay (47%), higher odds of intensive care unit admission (OR 8.1), longer intensive care unit stays (103%) and higher rate of surgical related complications (162%). Other independent variables of male gender, nonwhite race and prior comorbidities were independently associated with longer length of stay, higher intensive care unit admissions and higher risk of complications.
  
  
  CONCLUSIONS
  Surgeon volume, not hospital volume, is an important and consistent predictor of length of stay, intensive care unit admissions, intensive care unit days and complication rate after ureteroneocystostomy. These findings posit that the short length of stay, low intensive care unit admission rate and low complication rate reported in the literature may not be generalizable, but rather limited to higher volume surgeons.
authors.affiliation: Department of Urology, University of California, Davis, Sacramento, California 95817, USA.
authors.forename: Hao G
authors.initials: HG
authors.lastname: Nguyen
authors.forename: Karim
authors.initials: K
authors.lastname: Chamie
authors.forename: Khanh G
authors.initials: KG
authors.lastname: Nguyen
authors.forename: Blythe
authors.initials: B
authors.lastname: Durbin-Johnson
authors.forename: Eric A
authors.initials: EA
authors.lastname: Kurzrock
mesh_terms: D002675:Child, Preschool; D003559:Cystostomy; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods; D014718:Vesico-Ureteral Reflux / Q000601:surgery*