title: National Trends in Secondary Procedures Following Pediatric Pyeloplasty.
abstract: OBJECTIVE
  Although reported success rates after pediatric pyeloplasty to correct ureteropelvic junction are high, failure may require intervention. We sought to characterize the incidence and timing of secondary procedures after pediatric pyeloplasty using a national employer based insurance database.
  
  
  METHODS
  Using the MarketScan® database we identified patients 0 to 18 years old who underwent pyeloplasty from 2007 to 2013 with greater than 3 months of postoperative enrollment. Secondary procedures following the index pyeloplasty were identified by CPT codes and classified as stent/drain, endoscopic, pyeloplasty, nephrectomy or transplant. The risk of undergoing a secondary procedure was ascertained using Cox proportional hazards models adjusting for demographic and clinical characteristics.
  
  
  RESULTS
  We identified 1,976 patients with a mean ± SD followup of 23.9 ± 19.8 months. Overall 226 children (11.4%) had undergone at least 1 post-pyeloplasty procedure. The first procedure was done within 1 year in 87.2% of patients with a mean postoperative interval of 5.9 ± 11.1 months. Stents/drains, endoscopic procedures and pyeloplasties were noted in 116 (5.9%), 34 (1.7%) and 71 patients (3.1%), respectively. Length of stay was associated with undergoing a secondary procedure. Compared with 2 days or less the HR of 3 to 5 and 6 days or greater was 1.65 and 3.94 (p = 0.001 and <0.001, respectively).
  
  
  CONCLUSIONS
  Following pediatric pyeloplasty 1 of 9 patients undergoes at least 1 secondary procedure with the majority performed within the first year. One of 11 patients undergoes intervention more extensive than placement of a single stent or drain, requiring management strategies that generally signify recurrent or persistent obstruction. Estimates of pyeloplasty success in this national data set are lower than in other published series.
authors.affiliation: Department of Urology, University of Washington School of Medicine, Seattle, Washington. Electronic address: geolani@uw.edu.
authors.forename: Geolani W
authors.initials: GW
authors.lastname: Dy
authors.affiliation: Department of Urology, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Hsi
authors.affiliation: Department of Urology, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Holt
authors.affiliation: Division of Pediatric Urology, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Lendvay
authors.affiliation: Department of Urology, University of Washington School of Medicine, Seattle, Washington.
authors.forename: John L
authors.initials: JL
authors.lastname: Gore
authors.affiliation: Department of Urology, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Harper
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007682:Kidney Pelvis / Q000601:surgery*; D008297:Male; D012086:Reoperation / Q000639:trends; D017211:Treatment Failure; D014481:United States; D014517:Ureteral Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000639:trends*
keywords: hydronephrosis; kidney; minimally invasive surgical procedures; treatment failure; ureteral obstruction