Minimally invasive vs open pyeloplasty in children: the differential effect of procedure volume on operative outcomes.
OBJECTIVE
To assess the differential effect of volume-outcome dynamics on the outcomes of open pyeloplasty (OP) and minimally invasive pyeloplasty (MIP) in the management of pediatric ureteropelvic junction obstruction in the setting of increasing utilization of MIP.


METHODS
Within the Nationwide Inpatient Sample, a weighted estimate of 6006 pediatric patients (≤18 years; 2008-2010) with ureteropelvic junction obstruction underwent either OP or MIP. National trends in utilization and comparative effectiveness outcomes were examined in terms of intraoperative and postoperative complications, prolonged length of stay, and excessive hospital charges. Hospitals were stratified into volume quartiles. Specifically, the volume-outcome dynamics of the highest and lowest volume quartiles of both the approaches were examined with binary logistic regression models.


RESULTS
MIP accounted for 17.2% of cases during the study years. In individual multivariate models, high-volume OP patients had a significantly lower risk of developing postoperative complications, genitourinary complications, and excessive hospital charges compared with high-volume MIP, low-volume OP, and low-volume MIP patients. Regardless of hospital volume, MIP patients experienced shorter hospital stays.


CONCLUSIONS
Although there has been a substantial increase in the utilization of MIP, high-volume hospitals performing OP have the best perioperative outcomes in terms of postoperative complications, genitourinary complications, and overall hospital charges. However, high-volume hospitals performing MIP have better outcomes compared with low-volume hospitals performing OP. Shorter hospital stay is the one mitigating factor of MIP.
Center for Outcomes Research and Analytics, Henry Ford Health System, Detroit, MI; Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI.
Shyam
S
Sukumar
Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Quebec, Canada.
Orchidee
O
Djahangirian
Center for Outcomes Research and Analytics, Henry Ford Health System, Detroit, MI; Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI.
Akshay
A
Sood
Center for Outcomes Research and Analytics, Henry Ford Health System, Detroit, MI; Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI.
Jesse D
JD
Sammon
Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Briony
B
Varda
Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI.
Kirsten
K
Janosek-Albright
Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI.
Abd-El-Rahman
AE
Abd-El-Barr
Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Quebec, Canada.
Maxine
M
Sun
Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Electronic address: trinh.qd@gmail.com.
Quoc-Dien
QD
Trinh
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D007223:Infant; D007682:Kidney Pelvis / Q000601:surgery*; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D009392:Nephrectomy / Q000379:methods* / Q000592:standards*; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000601:surgery*