National trends in augmentation cystoplasty in the 2000s and factors associated with patient outcomes

Abstract

Purpose: Augmentation cystoplasty is a major surgery performed by pediatric urologists. We evaluated national estimates of children undergoing augmentation cystoplasty in the United States for trends during the 2000s, and analyzed patient and hospital factors associated with outcomes.

Materials and methods: Patients who underwent augmentation cystoplasty registered in the 2000 to 2009 Kids' Inpatient Database were included. Estimates of total number of augmentation cystoplasties performed and patient and hospital characteristics were evaluated for trends. Hierarchical models were created to evaluate patient and hospital factors associated with length of stay, total hospital charges and odds of having a postoperative complication.

Results: An estimated 792 augmentation cystoplasties were performed in 2000, which decreased to 595 in 2009 (p = 0.02). Length of stay decreased from 10.5 days in 2000 to 9.2 days in 2009 (p = 0.04). A total of 1,622 augmentation cystoplasties were included in the hierarchical models and 30% of patients had a complication identified. Patient factors associated with increased length of stay and increased odds of any complication included bladder exstrophy-epispadias complex diagnosis and older age. Pediatric hospitals had 31% greater total hospital charges (95% CI 7-55).

Conclusions: The estimated number of augmentation cystoplasties performed in children in the United States decreased by 25% in the 2000s, and mean length of stay decreased by 1 day. The cause of the decrease is multifactorial but could represent changing practice patterns in the United States. Of the patients 30% had a potential complication during hospitalization after augmentation cystoplasty. Older age and bladder exstrophy-epispadias complex diagnosis were associated with greater length of stay and increased odds of having any complication.

Keywords: AC; BEEC; HCUP; Healthcare Cost and Utilization Project; ICC; KID; Kids' Inpatient Database; LOS; NB; PHIS; Pediatric Health and Information System; SB; THC; US; United States; augmentation cystoplasty; bladder exstrophy; bladder exstrophy-epispadias complex; interclass correlation coefficient; length of stay; neurogenic bladder; spina bifida; spinal dysraphism; total hospital charge; urinary bladder; urologic surgical procedures.