Surgery for Pediatric Ureteropelvic Junction Obstruction

Comparison of Outcomes in Relation to Surgical Technique and Operating Discipline in Germany

verfasst von

G. Goetz, Mike Klora, Jan Zeidler, Svenja Eberhard, Stefan Bassler, Stephanie Mayer, Jan Hendrik Gosemann, Martin Lacher

Abstract

Introduction

Surgery for ureteropelvic junction obstruction (UPJO) is performed by both pediatric surgeons (PS) and urologists (URO). The aim of this study was to analyze treatment modalities for UPJO and results in relation to the surgical technique and the operating discipline in Germany.

Materials and Methods

Data of patients aged 0 to 18 years were extracted from a major public health insurance (covering ∼5.7 million clients) during 2009 to 2016 and were analyzed for sociodemographic variables, surgical technique, and treating discipline. Logistic regression analysis was performed for the risk of a complication within the first postoperative year.

Results

A total of 229 children (31.0% female) were included. Laparoscopic pyeloplasty (LP) was performed in 58 (25.3%) patients (8.6 ± 6.4 years), and open pyeloplasty (OP) was applied in 171 (74.7%; 4.6 ± 5.9 years). LP was the dominant technique in females (p < 0.02); males preferentially underwent OP (p < 0.02). Length of hospital stay was 4.3 days (p = 0.0005) shorter in LP compared with that in OP, especially in children ≤ 2 years (6.7 days, p = 0.007). PS operated on 162 children (70.7%), and URO performed surgery on 67 patients (29.3%). The mean age of children operated by PS (3.5 ± 4.7 years) was significantly younger compared with that operated by URO (10.8 ± 6.5 years, p < 0.0001). Complication rates were independent of surgical technique or treating specialty.

Conclusion

In Germany, UPJO was treated by LP in 25.3% of patients, which was associated with a shorter length of stay, especially in children ≤ 2 years. Complication rates were independent of the operating specialty and surgical technique. Therefore, LP should be further promoted for the treatment of UPJO in small children.

Organisationseinheit(en)

Center for Health Economics Research Hannover (CHERH)

Externe Organisation(en)

Universität Leipzig
AOK PLUS - Die Gesundheitskasse für Sachsen und Thüringen
AOK - Die Gesundheitskasse für Niedersachsen

Typ

Artikel

Journal

European journal of pediatric surgery

Band

Seiten

33-38

Anzahl der Seiten

ISSN

0939-7248

Publikationsdatum

2019

Publikationsstatus

Veröffentlicht

Peer-reviewed

ASJC Scopus Sachgebiete

Pädiatrie, Perinatalogie und Gesundheitsvorsorge bei Kindern, Chirurgie

Ziele für nachhaltige Entwicklung

SDG 3 – Gute Gesundheit und Wohlergehen

Elektronische Version(en)

https://doi.org/10.1055/s-0038-1668149 (Zugang: Geschlossen)