Correction of Ureteropelvic Junction Obstruction in Children: National Trends and Comparative Effectiveness in Operative Outcomes

PURPOSE: To assess the national trends and comparative effectiveness of the various treatments for pediatric ureteropelvic junction obstruction (UPJO). PATIENTS AND METHODS: Within the Nationwide Inpatient Sample, a weighted estimate of 35,275 pediatric patients (<19 years; 1998-2010) with UPJO underwent open pyeloplasty (OP), laparoscopic pyeloplasty (LP), robot-assisted pyeloplasty (RP, ≥October 2008) or endopyelotomy (EP). National trends in utilization and comparative effectiveness were evaluated. RESULTS: Minimally invasive pyeloplasty (RP+LP, MIP) utilization began to increase in 2007; MIP accounted for 16.9% of cases (2008-2010). EP accounted for 1.4% of all cases from 1998 to 2010. On individual multivariate models (relative to OP): (a) no significant differences were noted between groups for intraoperative complications; (b) RP and LP had equivalent risks of postoperative complications developing (vs OP), but EP had a significantly higher risk of postoperative complications; (c) RP and EP had significantly higher risks of necessitating transfusions; (d) RP, LP, and EP had higher overall risks of greater hospital charges; (e) RP had a lower risk of greater length of stay, while EP had a higher risk (LP and OP were equivalent). CONCLUSIONS: OP continues to be the predominant treatment for patients with UPJO. RP was the most common MIP modality in every age group. Compared with OP patients, RP patients had equivalent risk for intraoperative and postoperative complications, lower risk for greater length-of-stay, but higher risks for transfusions and greater hospital charges. LP patients had higher overall hospital charges, but no mitigating benefits relative to OP. EP fared poorly on most outcomes.