Early versus delayed closure of bladder exstrophy: A National Surgical Quality Improvement Program Pediatric analysis

被引:15
作者
Ahn, J. J. [1 ,2 ]
Shnorhavorian, M. [1 ,2 ]
Katz, C. [3 ]
Goldin, A. B. [3 ,4 ]
Merguerian, P. A. [1 ,2 ]
机构
[1] Seattle Childrens Hosp, Div Pediat Urol, Seattle, WA USA
[2] Univ Washington, Dept Urol, Seattle, WA 98195 USA
[3] Seattle Childrens Hosp, Div Pediat Surg, Seattle, WA USA
[4] Univ Washington, Dept Surg, Seattle, WA 98195 USA
关键词
Bladder exstrophy; Delayed closure; Complications; COMPLETE PRIMARY REPAIR; PRACTICE PATTERNS; AMERICAN-COLLEGE; MANAGEMENT;
D O I
10.1016/j.jpurol.2017.11.008
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Introduction Delayed closure of bladder exstrophy has become more popular; however, there is limited the evidence of its success. Existing literature focuses on intermediate and long-term outcomes, and short-term postoperative outcomes are limited by the small number of cases and varying follow-up methods. Objective The objectives of the current study were to: 1) compare 30-day complications after early and delayed closure of bladder exstrophy, and 2) evaluate practice patterns of bladder exstrophy closure. Study design The National Surgical Quality Improvement Program Pediatric (NSQIPP) database from 2012 to 2015 was reviewed for all cases of bladder exstrophy closure. Early closure was defined as surgery at age 0-3 days, and delayed closure was defined as age 4-120 days at time of surgery. Demographic, clinical, and perioperative characteristics were collected, as were postoperative complications, readmissions, and re-operations up to 30 days. Descriptive statistics were performed, and multivariate linear and logistic regression analyses were performed for salient complications. Results Of 128 patients undergoing bladder exstrophy closure, 62 were included for analysis, with 44 (71%) undergoing delayed closure. Mean anesthesia and operative times were greater in the delayed closure group, and were associated with more concurrent procedures, including inguinal hernia repairs and osteotomies. The delayed closure group had a higher proportion of 30-day complications, due to a high rate of blood transfusion (57% vs 11%). Wound dehiscence occurred in 6/44 (14%) delayed closures, as compared with 0/18 (0%) early closures. When compared with prior published reports of national data from 1999 to 2010, delayed closure was performed more frequently in this cohort (71% vs 27%). Discussion The NSQIPP provides standardized reporting of peri-operative characteristics and 30-day complications, allowing a comparison of early to delayed closure of bladder exstrophy across multiple institutions. Assessing short-term risks in conjunction with long-term follow-up is crucial for determining optimal management of this rare but complex condition. Conclusion Delayed closure of bladder exstrophy is performed frequently, yet it carries a high rate of 30-day complications worthy of further investigation. This can be useful in counseling patients and families, and to understand practice patterns across the country.
引用
收藏
页码:27.e1 / 27.e5
页数:5
相关论文
共 24 条
[1]  
Baird A D, 2007, J Pediatr Urol, V3, P311, DOI 10.1016/j.jpurol.2006.09.009
[2]   Delayed Primary Repair of Bladder Exstrophy: Ultimate Effect on Growth [J].
Baradaran, Nima ;
Cervellione, Raimondo M. ;
Stec, Andrew A. ;
Gearhart, John P. .
JOURNAL OF UROLOGY, 2012, 188 (06) :2336-2341
[3]  
Baradaran N, 2012, UROLOGY, V79, P415, DOI 10.1016/j.urology.2011.08.077
[4]   Hospital volume and surgical mortality in the United States. [J].
Birkmeyer, JD ;
Siewers, AE ;
Finlayson, EVA ;
Stukel, TA ;
Lucas, FL ;
Batista, I ;
Welch, HG ;
Wennberg, DE .
NEW ENGLAND JOURNAL OF MEDICINE, 2002, 346 (15) :1128-1137
[5]   Early outcome following complete primary repair of bladder exstrophy in the newborn [J].
Borer, JG ;
Gargollo, PC ;
Hendren, WH ;
Diamond, DA ;
Peters, CA ;
Atala, A ;
Grant, R ;
Retik, AB .
JOURNAL OF UROLOGY, 2005, 174 (04) :1674-1678
[6]  
Borer JG, 2017, J PEDIAT UROL
[7]   An Initial Report of a Novel Multi-Institutional Bladder Exstrophy Consortium: A Collaboration Focused on Primary Surgery and Subsequent Care [J].
Borer, Joseph G. ;
Vasquez, Evalynn ;
Canning, Douglas A. ;
Kryger, John V. ;
Mitchell, Michael E. .
JOURNAL OF UROLOGY, 2015, 193 (05) :1802-1807
[8]   American College of Surgeons National Surgical Quality Improvement Program Pediatric: A beta phase report [J].
Bruny, Jennifer L. ;
Hall, Bruce L. ;
Barnhart, Douglas C. ;
Billmire, Deborah F. ;
Dias, Mark S. ;
Dillon, Peter W. ;
Fisher, Charles ;
Heiss, Kurt F. ;
Hennrikus, William L. ;
Ko, Clifford Y. ;
Moss, Lawrence ;
Oldham, Keith T. ;
Richards, Karen E. ;
Shah, Rahul ;
Vinocur, Charles D. ;
Ziegler, Moritz M. .
JOURNAL OF PEDIATRIC SURGERY, 2013, 48 (01) :74-80
[9]  
Canning DA, 2012, SOC PED UR ANN M
[10]   The Management of Bladder Exstrophy: The Manchester Experience [J].
Dickson, Alan P. .
JOURNAL OF PEDIATRIC SURGERY, 2014, 49 (02) :244-250