title: National practice patterns and outcomes of pediatric nephrectomy: comparison between urology and general surgery.
abstract: OBJECTIVE
  In adults nephrectomy is under the purview of urologists, but pediatric urologists and pediatric general surgeons perform extirpative renal surgery in children. We compared the contemporary performance and outcome of all-cause nephrectomy at pediatric hospitals as performed by pediatric urologists and pediatric general surgeons.
  
  
  METHODS
  We queried the Pediatric Health Information System to identify patients 0 to 18 years old who were treated with nephrectomy between 2004 and 2013 by pediatric urologists and pediatric general surgeons. Data points included age, gender, severity level, mortality risk, complications and length of stay. Patients were compared by APR DRG codes 442 (kidney and urinary tract procedures for malignancy) and 443 (kidney and urinary tract procedures for nonmalignancy).
  
  
  RESULTS
  Pediatric urologists performed more all-cause nephrectomies. While pediatric urologists were more likely to operate on patients with benign renal disease, pediatric general surgeons were more likely to operate on children with malignancy. Patients on whom pediatric general surgeons operated had a higher average severity level and were at greater risk for mortality. After controlling for differences patients without malignancy operated on by pediatric urologists had a shorter length of stay, and fewer medical and surgical complications. There was no difference in length of stay, or medical or surgical complications in patients with malignancy.
  
  
  CONCLUSIONS
  Overall compared to pediatric general surgeons more nephrectomies are performed by pediatric urologists. Short-term outcomes, including length of stay and complication rates, appear better in this data set in patients without malignancy who undergo nephrectomy by pediatric urologists but there is no difference in outcomes when nephrectomy is performed for malignancy.
authors: College of Osteopathic Medicine, Michigan State University, Detroit, Michigan. Electronic address: kdsuson@gmail.com.
authors: Kristina D
authors: KD
authors: Suson
authors: Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, Michigan.
authors: Cortney
authors: C
authors: Wolfe-Christensen
authors: Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, Michigan; Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan.
authors: Jack S
authors: JS
authors: Elder
authors: College of Osteopathic Medicine, Michigan State University, Detroit, Michigan.
authors: Yegappan
authors: Y
authors: Lakshmanan
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D013502:General Surgery; D006801:Humans; D007674:Kidney Diseases / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D009392:Nephrectomy / Q000009:adverse effects / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014571:Urologic Neoplasms / Q000601:surgery; D014572:Urology
keywords: kidney; kidney neoplasms; nephrectomy; physician's practice patterns; treatment outcome