title: The Decline of the Open Ureteral Reimplant in the United States: National Data From 2003 to 2013.
abstract: OBJECTIVE
  To examine trends in the number of cases of primary vesicoureteral reflux managed by ureteral reimplantation nationally over the last decade. Substantial changes have occurred in management of vesicoureteral reflux (VUR) over time, but trends in use of ureteral reimplantation have yet to be investigated on a national scale with annualized data.
  
  
  METHODS
  Using the Premier Healthcare Database, we extracted hospital discharge data for pediatric patients (age ≤ 18 years) with a procedure code for ureteroneocystostomy (International Classification of Diseases, Ninth Revision, 56.74) between January 1, 2003 and December 31, 2013. We excluded patients with secondary VUR. The presence of a temporal trend in reimplantation was examined via regression using generalized estimating equations.
  
  
  RESULTS
  In 4301 cases of primary VUR (23,602 weighted), there was a substantial decrease in the number of reimplantations performed, with an estimated decline in the rate of 0.239 cases per attending per year (P = .006). Average patient age declined 1.2 months in each year (P < .0001) due largely to a decline in reimplantation in those over age 2, which fell by 0.15 reimplantations per attending per year (P = .026). There was no difference between rates of decline in reimplantation for children with and without reflux nephropathy (P = .21) CONCLUSION: Nationally there has been a marked decrease in the incidence of ureteral reimplantation among children with primary VUR. The potential factors contributing to this are broad, including changes in diagnostic patterns, treatment recommendations, and the rise of endoscopic intervention.
authors.affiliation: Boston Children's Hospital, Harvard Medical School, Boston, MA. Electronic address: michael.kurtz@childrens.harvard.edu.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Kurtz
authors.affiliation: Division of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Leow
authors.affiliation: Division of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Briony K
authors.initials: BK
authors.lastname: Varda
authors.affiliation: Boston Children's Hospital, Harvard Medical School, Boston, MA; Center for Clinical Research, Boston Children's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Tanya
authors.initials: T
authors.lastname: Logvinenko
authors.affiliation: Boston Children's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Joseph W
authors.initials: JW
authors.lastname: McQuaid
authors.affiliation: Boston Children's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Richard N
authors.initials: RN
authors.lastname: Yu
authors.affiliation: Boston Children's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Caleb P
authors.initials: CP
authors.lastname: Nelson
authors.affiliation: School of Medicine, Stanford University, Stanford, CA.
authors.forename: Benjamin I
authors.initials: BI
authors.lastname: Chung
authors.affiliation: Division of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Chang
mesh_terms: D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D012092:Replantation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014481:United States; D014513:Ureter / Q000601:surgery*; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*