title: The need for additional procedures in patients undergoing proximal hypospadias repairs as reported in the pediatric health information system database.
abstract: OBJECTIVE
  Using administrative data from freestanding pediatric hospitals in the United States, we characterized the frequency and type of additional procedures required in patients undergoing proximal hypospadias repair in a larger cohort than in published case series across multiple surgeons and institutions.
  
  
  METHODS
  A search of the Pediatric Health Information System (PHIS) database by CPT code between January 1, 2005 and June 30, 2010 identified patients undergoing 1 or 2-stage repair for proximal hypospadias. Patient records with inconsistent coding or the suggestion of an alternate pathological condition were excluded from study. A forward query to June 30, 2011 identified additional hypospadias related interventions by CPT codes.
  
  
  RESULTS
  We identified 1,679 patients from a total of 37 hospitals. Potential followup was 1 to 6.5 years. One-stage repair was performed in 85.7% of patients at a median age of 10 months. In patients undergoing 2-stage repair the median age at initial repair was 10 months and the median interval between stages was 6 months. Of all patients 26.2% required 1 or more additional interventions beyond definitive repair. Of all additional interventions 84.0% were open, 7.2% were endoscopic treatment for stricture, 0.4% were combined endoscopic and open interventions, and 8.4% were endoscopic evaluation. The median interval from definitive repair to the first intervention was 9 months.
  
  
  CONCLUSIONS
  These data indicate that more than a quarter of patients who underwent proximal hypospadias repair at pediatric hospitals required additional intervention(s) after what was thought to be definitive repair. These data help create a broader context in a contemporary cohort of patients treated with proximal hypospadias repair.
authors: Connecticut Children's Medical Center, Hartford, Connecticut.
authors: Katherine W
authors: KW
authors: Herbst
authors: Fernando A
authors: FA
authors: Ferrer
authors: John H
authors: JH
authors: Makari
mesh_terms: D016208:Databases, Factual; D005500:Follow-Up Studies; D063005:Health Information Systems; D006801:Humans; D007021:Hypospadias / Q000453:epidemiology / Q000601:surgery*; D007231:Infant, Newborn; D008297:Male; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013524:Surgical Flaps; D013997:Time Factors; D013521:Urologic Surgical Procedures, Male / Q000379:methods / Q000706:statistics & numerical data*
keywords: endoscopy; hypospadias; reconstructive surgical procedures; reoperation; urethra