Early outcomes and risk factors for complications following pediatric neurogenic bladder reconstruction: A secondary analysis of the pediatric NSQIP database (2015-2020).

Abstract

Introduction: Surgical management of pediatric neurogenic bladder (NB) and bowel aims to achieve safe filling pressures and achieve dryness, simultaneously allowing independence to manage voiding functions. The surgical armamentarium includes; augmentation cystoplasty (AC), bladder neck reconstruction (BNR), Mitrofanoff procedure (MP) and cecostomy (MACE). Often, patients undergo these procedures concomitantly, based on urodynamic and clinical findings.

Objective: This study aims to determine the 30-day outcomes of pediatric NB reconstructive surgery, and identify independent risk factors for an early adverse outcome.

Study design: This study is a secondary analysis of prospectively collected data from the National Surgical Quality Improvement Program (NSQIP) Pediatric database between 2015 and 2020. Patients <18 years of age with an International Classification of Disease, Ninth and Tenth Revision (ICD-9/10) diagnosis of Spina Bifida (SB) undergoing a urological reconstruction defined with specific Current Procedural Terminology (CPT) codes were included. Patient demographics, perioperative variables, operative timing, length of stay, 30-day readmission/reoperation data and surgical complications were assessed. Patients were categorized into four surgical groups: 1: MP only; 2: isolated BNR; 3: AC ± MP; 4: AC + BNR + MP ± MACE. A multivariable logistic regression analysis was conducted to identify risk factors for 30-day readmission and re-operation using age, body mass index (BMI), operative time and surgical groups as independent variables.

Results: We identified a cohort of 700 patient encounters involving at least one of these procedures, with a median age at surgery of 10.3 years (Interquartile Range [IQR] 6.6-13.6). The majority were females (58.3 %) and 53.6 % had a normal BMI, 18.3 % were overweight and 28.1 % were obese. The overall early complication rate ranged from 14.8 % to 27.2 %, with a 15.1 % readmission rate and reoperation rate was 7.9 % following pediatric NB reconstruction. Multivariable logistic regression analysis indicated that those in surgical group 4 were 2.78 times (95 % CI-1.03 - 7.49) more likely for 30-day readmission, compared to Group 1 (p = .04). Multivariable analysis revealed no significant predictors of 30-day reoperation.

Discussion: Age at surgery, BMI and operative time do not predict the risk of surgical complications following NB reconstruction. We validated that increasing procedure count was associated with increased risk of 30-day readmission.

Conclusion: Increasing the number of surgical interventions for NB reconstruction is associated with higher 30-day readmission rates, while increasing age at surgery and BMI did not predict readmission or reoperation. The results of this study are generalizable, given the cohort, and can help pediatric urologists prognosticate early patient outcomes following major NB reconstructive surgeries.