Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Jun 9, 2025; 14(2): 99455
Published online Jun 9, 2025. doi: 10.5409/wjcp.v14.i2.99455
Factors and outcomes leading to postoperative emergency department visits after ureteroneocystostomy
Young Son, Mark Quiring, Scott Serpico, Edward Wu, Ethan Wood, Shelby Deynzer, Will Olive, Brittney Henderson, Hira Choudhry, Aws Ahmed, Usama Aljameey, Danielle Terrenzio, Gregory E Dean
Young Son, Mark Quiring, Department of Urology, Jefferson New Jersey Urology, Stratford, NJ 08084, United States
Scott Serpico, Danielle Terrenzio, College of Osteopathic Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, PA 19131, United States
Edward Wu, Department of Urology, Maimonides Medical Center, Brooklyn, NY 11219, United States
Ethan Wood, College of Osteopathic Medicine, Oklahoma State University, Tulsa, OK 74107, United States
Shelby Deynzer, Department of Urology, Institute for Academic Medicine, Charleston, WV 25304, United States
Will Olive, Usama Aljameey, DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, TN 37752, United States
Brittney Henderson, College of Osteopathic Medicine, Philadelphia College of Osteopathic Medicine Georgia, Suwanee, GA 30024, United States
Hira Choudhry, College of Osteopathic Medicine, Touro University, Middletown, NY 10940, United States
Aws Ahmed, Department of Surgery, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614-1700, United States
Gregory E Dean, Department of Pediatric Urology, Temple University School of Medicine, Philadelphia, PA 19140, United States
Author contributions: Son Y, Quiring M, Serpico S, Wu E, and Dean GE designed the research study; Son Y, Quiring M, Serpico S, Wood E, Deynzer S, and Olive W performed the research; Wu E, Olive W, and Coudhry H contributed new reagents and analytic tools; Son Y, Quiring ME, Serpico S, Wood E, Deynzer S, Henderson B, Ahmed A, Aljameey U, and Terrenzio D analyzed the data and wrote the manuscript. All authors have read and approved the final manuscript.
Institutional review board statement: This study does not constitute human subjects research, and thus was approved to proceed without IRB approval or exemption.
Informed consent statement: The need for patient consent was waived due to the retrospective nature of the study.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose regarding the publication of this manuscript.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mark Quiring, Department of Urology, Jefferson New Jersey Urology, 101 E Laurel Road, Suite B, Stratford, NJ 08084, United States. mxq150@jefferson.edu
Received: August 1, 2024
Revised: December 26, 2024
Accepted: January 23, 2025
Published online: June 9, 2025
Processing time: 228 Days and 7.9 Hours
Abstract
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.

Keywords: Ureteroneocystostomy; Pediatric urology; Vesicoureteral reflux; Urinary tract infection; Postoperative complication; Surgical site infections

Core Tip: Ureteroneocystostomy (UNC) is the gold standard for pediatric vesicoureteral reflux treatment but has high postoperative emergency department (ED) visit rates. Analyzing 2020 data from 1495 patients, we identified key risk factors for ED visits within 30 days post-UNC, including postoperative urinary tract infections, surgical site infections, unplanned procedures, urinary catheter placements, and prematurity. These findings underscore the necessity for stringent discharge protocols to reduce postoperative ED visits, emphasizing the management of infections and other modifiable risk factors to enhance patient outcomes and minimize complications.