title: Contemporary national comparison of open, laparoscopic, and robotic-assisted laparoscopic pediatric pyeloplasty.
abstract: OBJECTIVE
  We sought to determine current and longitudinal trends in the usage of open (OP), laparoscopic (LP), and robotic pyeloplasties. (RALP) Furthermore, we aimed to describe patient and hospital level characteristics associated with the use of minimally invasive pyeloplasties (MIP) and to compare basic utilization metrics for each approach.
  
  
  METHODS
  The 2000, 2003, 2006, and 2009 Kid's Inpatient Databases (KID) were used to determine current and longitudinal trends. As a result of a specific billing code for robotic surgery introduced in 2008, the 2009 KID database was used for analysis of RALP. Patient and hospital characteristics examined included: age, gender, race, insurance status, hospital location, and academic status. Utilization metrics of length of stay (LOS) and cost were determined from each modality.
  
  
  RESULTS
  In 2009, there were 3354 pediatric pyeloplasties performed in the USA (85% OP, 3% LP, 12% RP). Compared with 2000, this represents an 11.7% decrease in the overall number of pyeloplasties but a progressive increase in MIP from 0.34% in 2000 to 11.7%. Mean patient age was 3.7 years for OP, 9.3 years for LP and 9.9 years for RALP. MIP was more commonly performed in females, Caucasians, patients with private insurance, at urban hospitals and at teaching hospitals. Although length of stay (LOS) in days was statistically lower for MIP (3.46 OP, 2.86 LP, 1.96 RP, p < 0.001), total cost between the groups was not statistically different. On multivariable logistic regression analysis, age (OR 1.17, p < 0.001) increased the odds of MIP whereas lack of private insurance decreased the odds of MIP (OR 0.62, p = 0.002).
  
  
  CONCLUSIONS
  Although utilization of MIP is increasing in the USA, especially in older children, OP remains predominant. MIP was associated with a decrease in LOS. The odds of MIP were higher in older children, whereas the lack of private insurance decreased the odds of MIP.
authors.affiliation: Division of Pediatric Urology, Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. Electronic address: dbliu@luriechildrens.org.
authors.forename: Dennis B
authors.initials: DB
authors.lastname: Liu
authors.affiliation: Division of Pediatric Urology, Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Urology, Loyola University Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA.
authors.forename: Chandy
authors.initials: C
authors.lastname: Ellimoottil
authors.affiliation: Division of Pediatric Urology, Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Flum
authors.affiliation: Division of Pediatric Urology, Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Jessica T
authors.initials: JT
authors.lastname: Casey
authors.affiliation: Division of Pediatric Urology, Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Edward M
authors.initials: EM
authors.lastname: Gong
mesh_terms: D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D065287:Robotic Surgical Procedures / Q000191:economics / Q000706:statistics & numerical data*; D014481:United States; D014517:Ureteral Obstruction / Q000191:economics / Q000601:surgery*
keywords: Kids' inpatient database; Laparoscopic pyeloplasty; Minimally invasive pyeloplasty; Pediatric ureteropelvic junction obstruction; Robotic pyeloplasty