title: Open Vs Minimally Invasive Adult Ureteral Reimplantation: Analysis of 30-day Outcomes in the National Surgical Quality Improvement Program (NSQIP) Database.
abstract: OBJECTIVE
  To examine 30-day outcomes of robotic-assisted and pure laparoscopic ureteral reimplantation (LUR) vs open ureteral reimplantation (OUR) in adult patients for benign disease.
  
  
  METHODS
  We identified adult patients undergoing LUR or OUR by urologists between 2006 and 2013 using the American College of Surgeons National Surgical Quality Improvement Program database, excluding those with concomitant partial cystectomy or ureterectomy. Multivariable regression modeling was used to assess for the independent association of minimally invasive surgery (MIS) with 30-day complications, reoperations, or readmissions.
  
  
  RESULTS
  Of 512 patients identified, 300 underwent LUR and 212 underwent OUR. Baseline characteristics including age, race, body mass index, and cardiovascular comorbidities were similar between LUR and OUR (all P > .05). Patients who underwent LUR had higher median preoperative serum creatinine (1.1 mg/dL vs 1.0 mg/dL, P = .03), increased presence of a resident (51% vs 34%, P < .01), and shorter hospitalization (1 [interquartile range 0-3] days vs 4 [interquartile range 3-6] days, P < .01) compared to patients who underwent OUR. LUR had lower overall complications (9% vs 28%, P < .01), especially with regard to transfusions (1% vs 11%, P < .01), superficial wound infections (0% vs 5%, P < .01), and urinary tract infections (5% vs 11%, P = .03). On multiple regression analyses, MIS was an independent predictor of lower overall complication rate (odds ratio [OR] 0.24 [0.14-0.40], P < .01), but was not predictive of readmission (OR 0.93 [0.44-1.98], P = .16) or reoperation (OR 2.09 [0.90-4.82], P = .10).
  
  
  CONCLUSIONS
  In the largest current series assessing the impact of MIS on adult ureteral reimplantation, data from the National Surgical Quality Improvement Program demonstrate that LUR results in decreased 30-day complications.
authors.affiliation: Section of Urology, University of Chicago, Chicago, IL. Electronic address: vignesh.packiam@uchospitals.edu.
authors.forename: Vignesh T
authors.initials: VT
authors.lastname: Packiam
authors.affiliation: Section of Urology, University of Chicago, Chicago, IL.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Cohen
authors.affiliation: Section of Urology, University of Chicago, Chicago, IL.
authors.forename: Charles U
authors.initials: CU
authors.lastname: Nottingham
authors.affiliation: Section of Urology, University of Chicago, Chicago, IL.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Pariser
authors.affiliation: Section of Urology, University of Chicago, Chicago, IL.
authors.forename: Sarah F
authors.initials: SF
authors.lastname: Faris
authors.affiliation: Section of Urology, University of Chicago, Chicago, IL.
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Bales
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications / Q000453:epidemiology; D058996:Quality Improvement; D012092:Replantation / Q000379:methods*; D065287:Robotic Surgical Procedures; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014513:Ureter / Q000601:surgery*; D014515:Ureteral Diseases / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods