title: Comparison of 30-day perioperative outcomes in adults undergoing open versus minimally invasive pyeloplasty for ureteropelvic junction obstruction: analysis of 593 patients in a prospective national database.
abstract: OBJECTIVE
  The surgical correction of ureteropelvic junction obstruction (UPJO) is indicated to prevent progression to chronic renal insufficiency. Minimally invasive surgery (MIS) has become increasingly popular as an approach to UPJO correction. We compared the perioperative outcomes between minimally invasive (MIP) and open pyeloplasty (OP) in the adult population.
  
  
  METHODS
  The current study was performed using the American College of Surgeons National Surgical Quality Improvement Program. Patients were identified using Current Procedural Terminology codes for pyeloplasty between 2005 and 2012, and were stratified according to either MIS or open approach. Patients with a diagnosis of malignant neoplasm of the kidney were excluded. Following exclusions, 593 patients remained for analysis. Primary outcomes of interest were overall perioperative complications, need for transfusions, re-intervention rate, prolonged operation time (pOT), prolonged length of stay (pLOS), readmission and mortality within 30 days of surgery. Multivariable logistic regression analyses were performed to examine the association between preoperative outcomes and surgical approach.
  
  
  RESULTS
  In this study, 423 (71.3 %) patients underwent MIP and 170 (28.7 %) underwent OP. Patients who underwent MIP had a decreased risk of wound [Odds ratio (OR) 0.06, p < 0.009] and overall complications (OR 0.21, p < 0.001), transfusions (OR 0.04, p = 0.004) and pLOS [pLOS (OR 0.08, p < 0.001)]. Conversely, MIP was associated with an increased likelihood of pOT (OR 2.26, p = 0.002).
  
  
  CONCLUSIONS
  Adults with UPJO undergoing MIP have a lower risk of overall complications, transfusions and pLOS compared to OP. Further studies are needed to determine whether these benefits offset the increase in expenditures, related to longer operative time and costs of disposables.
authors.affiliation: Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, ASB II-3, Boston, MA, 02115, USA. j.hanske@gmx.de.|Department of Urology, Marien Hospital, Ruhr-University Bochum, Widumer Strasse 8, 44627, Herne, Germany. j.hanske@gmx.de.
authors.forename: Julian
authors.initials: J
authors.lastname: Hanske
authors.affiliation: Department of Urology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. asanchez6@partners.org.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Sanchez
authors.affiliation: Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, ASB II-3, Boston, MA, 02115, USA. dr.marianne.schmid@gmail.com.|Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. dr.marianne.schmid@gmail.com.
authors.forename: Marianne
authors.initials: M
authors.lastname: Schmid
authors.affiliation: Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, ASB II-3, Boston, MA, 02115, USA. christian.p.meyer@gmail.com.|Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. christian.p.meyer@gmail.com.
authors.forename: Christian P
authors.initials: CP
authors.lastname: Meyer
authors.affiliation: Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202-2689, USA. firas.abdollah@gmail.com.
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.affiliation: Department of Urology, Marien Hospital, Ruhr-University Bochum, Widumer Strasse 8, 44627, Herne, Germany. f.roghmann@gmail.com.
authors.forename: Florian
authors.initials: F
authors.lastname: Roghmann
authors.affiliation: Department of Urology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. afeldman@partners.org.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Feldman
authors.affiliation: Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, ASB II-3, Boston, MA, 02115, USA. akibel@partners.org.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Kibel
authors.affiliation: Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202-2689, USA. jsammon79@gmail.com.
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Sammon
authors.affiliation: Department of Urology, Marien Hospital, Ruhr-University Bochum, Widumer Strasse 8, 44627, Herne, Germany. joachim.noldus@marienhospital-herne.de.
authors.forename: Joachim
authors.initials: J
authors.lastname: Noldus
authors.affiliation: Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, ASB II-3, Boston, MA, 02115, USA. trinh.qd@gmail.com.
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
authors.affiliation: Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, ASB II-3, Boston, MA, 02115, USA. jeswara@partners.org.
authors.forename: Jairam R
authors.initials: JR
authors.lastname: Eswara
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement; D016896:Treatment Outcome; D014481:United States; D014517:Ureteral Obstruction / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D055815:Young Adult
keywords: Adult; Minimally invasive; NSQIP; Pyeloplasty; Ureteropelvic junction obstruction