Factors and outcomes leading to postoperative emergency department visits after ureteroneocystostomy.

Background: Ureteroneocystostomy (UNC) is considered the gold standard for pediatric vesicoureteral reflux (VUR) treatment. While UNC lowers the likelihood of needing additional VUR procedures within 12 months, patients also have high 30-day and 90-day readmission rates and emergency department (ED) visits. The most common causes of an ED visit following any urologic procedure are urinary tract infections (UTIs) and catheter/drain concerns. Prior studies are limited in identifying predisposing factors to help mitigate complications of UNC and improve patient outcomes.

Aim: To identify modifiable characteristics at the time of discharge after UNC that predict subsequent unplanned ED visits.

Methods: The 2020 American College of Surgeons National Surgical Quality Improvement Program Pediatric data was analyzed for patients undergoing UNC for VUR. A total of 1742 patients were evaluated, with 1495 meeting inclusion criteria. Patients with an ED visit within 30 days following an anti-reflux procedure (n = 164) were compared to those who did not return to the ED (n = 1331). Basic statistics and logistic regression analysis were performed to find predictive factors associated with postoperative ED visits after UNC.

Results: Among the 1495 patients, 11.0% visited the ED within the 30-day postoperative period. Patients who returned to the ED visit following UNC were more likely to have had a longer mean operative time, surgical site infection, postoperative UTI, postoperative sepsis, history of prior readmission, unplanned reoperation, blood transfusion, or unplanned urinary catheter placement. Multivariate analysis revealed postoperative UTI (P < 0.001), superficial surgical site infection (P = 0.022), unplanned procedure (P < 0.001), unplanned urinary catheter (P < 0.001), and prematurity (35-36 weeks gestation) (P = 0.004) as independent risk factors for postoperative ED visits.

Conclusion: Utmost caution is needed prior to discharge after UNC to forestall a return to the ED. Postoperative infection remains a primary risk for ED visits in the acute postoperative period.