Contemporary trends in surgical correction of pediatric ureteropelvic junction obstruction: data from the nationwide inpatient sample.

PURPOSE

The presentation and diagnosis of ureteropelvic junction obstruction have changed in the last 20 years. We describe trends in pediatric surgical correction of ureteropelvic junction obstruction between 1988 and 2000.

MATERIALS AND METHODS

The Nationwide Inpatient Sample contains data on approximately 5 million to 7 million hospital inpatient stays per year, approximating a 20% sample of United States hospitals. We used International Classification of Disease-9 codes to identify pediatric pyeloplasty cases, and analyzed the data for practice patterns.

RESULTS

A total of 5,858 pediatric patients (mean age 62.8 months) underwent pyeloplasty. Males comprised 70.7% of the sample, and tended to undergo surgery at a younger age (60.1 vs 69.4 months, p <0.0001). The proportion of procedures done during the first 6 months of life decreased from 34.2% (1988 to 1991) to 25.2% (1997 to 2000, p <0.0001). Nonwhites underwent surgery in the first 6 months more often than whites (38.9% vs 25.0%, p <0.0001) and had a lower mean age at surgery (44.4 vs 70.7 months, p <0.0001). The percentage of procedures done at urban teaching hospitals increased from 48.9% (1988 to 1991) to 61.3% (1997 to 2000, p <0.0001). Length of stay decreased significantly from 6.7 days (1988 to 1991) to 3.7 days (1997 to 2000, p <0.0001).

CONCLUSIONS

Practice patterns in pediatric pyeloplasty evolved between 1988 and 2000. Fewer procedures are being performed in newborns, suggesting that patients with prenatal hydronephrosis are increasingly being observed instead of undergoing early surgery. There was a substantial difference in timing of surgery between whites and nonwhites. To our knowledge this observation has not previously been reported. More procedures are being performed at teaching hospitals, and length of stay has decreased significantly.