Department of Urology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
BJU Int. 2013 Jun;111(7):1141-7. doi: 10.1111/bju.12039. Epub 2013 Mar 19.
To describe the extent of use and in-hospital outcomes of open and laparoscopic pyeloplasty for paediatric pelvi-ureteric junction (PUJ) obstruction in the USA.
Using the 2004-2008 Nationwide Inpatient Sample, we identified 4590 paediatric patients (≤18 years old) who underwent open or laparoscopic pyeloplasty for PUJ obstruction at 195 hospitals. Multivariable regression models were used to test the associations between hospital and patient covariates (age, gender, race, primary health insurance), type of admission (emergent vs elective), and hospital characteristics (teaching vs non-teaching status; rural vs urban location) with complications, length of stay (LOS), and total hospitalization costs.
During the 5-year study interval, 4426 (96.4%) and 164 (3.6%) paediatric patients diagnosed with PUJ obstruction underwent open and laparoscopic pyeloplasty, respectively. The proportion of patients undergoing laparoscopic pyeloplasty gradually increased from 2.4% in 2004 to 4.4% in 2008, but this increase was not significant (P = 0.22 for trend). On multivariable analysis, laparoscopic pyeloplasty was observed to have rates of postoperative complications (2.51 vs 5.00; P = 0.67), LOS (2.42 vs 2.75; P = 0.33) and total hospitalization cost ($9755 vs $8537; P = 0.24) similar to those of open pyeloplasty.
While laparoscopic pyeloplasty was generally an infrequent operation performed for paediatric PUJ obstruction during the period studied, this minimally invasive surgery provided similar outcomes in terms of in-hospital complications, LOS and total hospitalization costs. The results of this study inform policymakers about the comparative effectiveness of laparoscopic and open pyeloplasty.
描述美国儿童肾盂输尿管连接部（PUJ）梗阻行开放和腹腔镜肾盂成形术的使用程度和院内结局。
利用 2004 年至 2008 年全国住院患者样本，我们在 195 家医院确定了 4590 名接受开放或腹腔镜肾盂成形术治疗 PUJ 梗阻的儿科患者（≤18 岁）。多变量回归模型用于检验医院和患者特征（年龄、性别、种族、主要医疗保险）、入院类型（急诊与择期）和医院特征（教学与非教学状态；农村与城市位置）与并发症、住院时间（LOS）和总住院费用之间的关联。
在 5 年研究期间，4426 名（96.4%）和 164 名（3.6%）诊断为 PUJ 梗阻的儿科患者分别接受了开放和腹腔镜肾盂成形术。行腹腔镜肾盂成形术的患者比例从 2004 年的 2.4%逐渐增加到 2008 年的 4.4%，但这一增加并不显著（趋势检验 P = 0.22）。多变量分析显示，腹腔镜肾盂成形术术后并发症发生率（2.51% vs 5.00%；P = 0.67）、住院时间（2.42 天 vs 2.75 天；P = 0.33）和总住院费用（$9755 美元 vs $8537 美元；P = 0.24）与开放肾盂成形术相似。
尽管在研究期间腹腔镜肾盂成形术通常是一种治疗儿童 PUJ 梗阻的罕见手术，但这种微创手术在院内并发症、住院时间和总住院费用方面提供了相似的结果。本研究的结果为决策者提供了关于腹腔镜和开放肾盂成形术的比较效果信息。
