Investig Clin Urol.  2018 May;59(3):200-205. 10.4111/icu.2018.59.3.200.

Relative to open surgery, minimally-invasive renal and ureteral pediatric surgery offers no improvement in 30-day complications, yet requires longer operative time: Data from the National Surgical Quality Improvement Program Pediatrics

• Colaco M
• Hester A
• Visser W
• Rasper A
• Terlecki R

• KMID: 2410594
• DOI: http://doi.org/10.4111/icu.2018.59.3.200

Abstract

PURPOSE
Performance of minimally-invasive surgery (MIS) is increasing relative to open surgery. We sought to compare the contemporary rates of short-term complications of open versus laparoscopic renal and ureteral surgery in pediatric patients.
MATERIALS AND METHODS
A retrospective cross-sectional analysis of the National Surgical Quality Improvement Program Pediatrics database was performed of all cases in 2014 identified using CPT procedure codes for nephrectomy, partial nephrectomy (PN), ureteroneocystostomy (UNC), and pyeloplasty, and reviewed for postoperative complications. Univariate analysis was performed to determine 30-day complications, with comparison between open and MIS approaches. Receiver operator curve (ROC) analysis was performed to determine differences in body surface area (BSA) and age for open versus MIS.
RESULTS
Review identified 207 nephrectomies, 72 PN, 920 UNC, and 625 pyeloplasties. MIS was associated with older age and larger BSA except for cases of UNC. Apart from PN, operative durations were longer with MIS. However, only PN was associated with significantly longer length of hospital stay (LOS). There was no difference in incidence of all other 30-day complications. When evaluating BSA via ROC, the area under the curve (AUC) was found to be 0.730 and was significant. Children with a BSA greater than 0.408 m2 were more likely to have MIS (sensitivity, 66.9%; specificity, 69.3%). Regarding age, the AUC was 0.732. Children older than 637.5 days were more likely to have MIS (sensitivity, 72.8%; specificity, 63.3%).
CONCLUSIONS
Pediatric MIS is associated with longer operative time for nephrectomy, but shorter LOS following PN. Surgical approach was not associated with difference in short-term complications.

Keyword

Complications; Kidney; Minimally invasive surgical procedures; Pediatrics; Postoperative period

MeSH Terms

Area Under Curve
Body Surface Area
Child
Cross-Sectional Studies
Humans
Incidence
Kidney
Length of Stay
Minimally Invasive Surgical Procedures
Nephrectomy
Operative Time*
Pediatrics*
Postoperative Complications
Postoperative Period
Quality Improvement*
Retrospective Studies
Sensitivity and Specificity
Ureter*

Figure

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  Fig. 1 Receiver operator curves (ROCs) for open versus minimally-invasive pyeloplasty to determine set points of (A) body surface area and (B) age above which children are more likely to undergo minimally-invasive surgery. Diagonal segments are produced by ties.

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