Inpatients hypospadias care: trends and outcomes from the American nationwide inpatient sample.
OBJECTIVE
Hypospadias is the most common congenital penile anomaly. Information about current utilization patterns of inpatient hypospadias repair as well as complication rates remain poorly evaluated.


METHODS
The Nationwide Inpatient Sample was used to identify all patients undergoing inpatient hypospadias repair between 1998 and 2010. Patient and hospital characteristics were attained and outcomes of interest included intra- and immediate postoperative complications. Utilization was evaluated temporally and also according to patient and hospital characteristics. Predictors of complications and excess length of stay were evaluated by logistic regression models.


RESULTS
A weighted 10,201 patients underwent inpatient hypospadias repair between 1998 and 2010. Half were infants (52.2%), and were operated in urban and teaching hospitals. Trend analyses demonstrated a decline in incidence of inpatient hypospadias repair (estimated annual percentage change, -6.80%; range, -0.51% to -12.69%; p=0.037). Postoperative complication rate was 4.9% and most commonly wound-related. Hospital volume was inversely related to complication rates. Specifically, higher hospital volume (>31 cases annually) was the only variable associated with decreased postoperative complications.


CONCLUSIONS
Inpatient hypospadias repair have substantially decreased since the late 1990's. Older age groups and presumably more complex procedures constitute most of the inpatient procedures nowadays.
Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. ; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Christian
C
Meyer
Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
Shyam
S
Sukumar
Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
Akshay
A
Sood
Department of Urology, Marienhospital Herne, Ruhr University Bochum, Bochum, Germany.
Julian
J
Hanske
Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Malte
M
Vetterlein
Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA. ; Department of Urology, Children's Hospital of Michigan, Detroit, MI, USA.
Jack S
JS
Elder
Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Margit
M
Fisch
Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Quoc-Dien
QD
Trinh
Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
Ariella A
AA
Friedman
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D006760:Hospitalization / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D007021:Hypospadias / Q000453:epidemiology / Q000601:surgery*; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data / Q000639:trends; D008297:Male; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D016526:Workload / Q000706:statistics & numerical data; D055815:Young Adult
Hypospadias; Inpatients; Outcome assessment; Postoperative complications