Factors and outcomes leading to postoperative emergency department visits after ureteroneocystostomy

Table 1 Patient demographics and comorbidities for patients with an emergency department visit following ureteroneocystostomy, n (%)/mean ± SD

Patient demographics	Total cohort (n = 1495)	Postoperative ED visit (n = 164)	No Postoperative ED visit (n = 1331)	P value1
Age	1666 ±1208	1605.5 ± 1207	1673.3 ± 1196	0.4974
Male gender	446 (29.8)	55 (33.5)	391 (29.4)	0.2720
Non-Caucasian race	304 (20.3)	38 (23.2)	266 (20.0)	0.9070
Hispanic ethnicity	201 (13.4)	23 (14.0)	178 (13.4)	0.0109
Inpatient	1010 (67.6)	120 (73.2)	890 (65.9)	0.1038
Height	40.2 ± 8.9	39.0 ± 8.3	40.3 ± 8.6	0.4041
Weight	42.0 (24.3)	39.3 (22.5)	42.2 (24.5)	0.0696
Comorbid conditions/past medical history
Ventilator dependent	2 (0.1)	1 (0.6)	1 (0.1)	0.0773
History of asthma	25 (1.7)	5 (3.0)	20 (1.5)	0.1453
Bronchopulmonary dysplasia/chronic lung disease	14 (0.9)	3 (1.8)	11 (0.8)	0.2085
Oxygen support	10 (0.7)	2 (1.2)	8 (0.6)	0.3594
Tracheostomy	2 (0.1)	0 (0.0)	2 (0.1)	0.6195
Structural pulmonary/airway abnormalities	32 (2.1)	7 (4.3)	25 (1.9)	0.0461
Esophageal/gastric/intestinal disease	81 (5.4)	15 (9.1)	66 (5.0)	0.0254
History of cardiac surgery	30 (2.0)	3 (1.8)	27 (2.0)	0.8637
Developmental delay/impaired cognitive status	100 (6.7)	15 (9.1)	85 (6.4)	0.1820
Seizure disorder	17 (1.1)	3 (1.8)	14 (1.1)	0.3758
Cerebral palsy	6 (0.4)	2 (1.2)	4 (0.3)	0.0791
Structural CNS abnormality	65 (4.3)	9 (5.5)	56 (4.2)	0.4482
Neuromuscular disorder	35 (2.3)	7 (4.3)	28 (2.1)	0.0838
Ostomy	71 (4.7)	13 (7.9)	58 (4.4)	0.0427
Congenital malformation	1144 (76.5)	130 (79.3)	1014 (76.2)	0.6228
Childhood malignancy	4 (0.3)	0 (0.0)	4 (0.3)	0.7811
Steroid use (Within 30 days)	6 (0.4)	2 (1.2)	4 (0.3)	0.0791
Nutritional support	30 (2.0)	5 (3.0)	25 (1.9)	0.3133
Hematologic disorder	33 (2.2)	3 (1.8)	30 (2.3)	0.7270

¹The P value represents tests for significant variation from χ² analysis of categorical variables, t-test for continuous factors with equal variance.

ED: Emergency department; CNS: Central nervous system.

Table 2 Patient demographics and comorbidities for patients with an emergency department visit following ureteroneocystostomy (cont.), n (%)

	Total cohort (n = 1495)	Postoperative ED visit (n = 164)	No postoperative ED visit (n = 1331)	P value1
Premature birth
25-30 weeks	15 (1.0)	1 (0.6)	14 (1.1)	1.000
31-34 weeks	39 (2.6)	6 (3.7)	33 (2.5)	0.4303
35-36 weeks	70 (4.7)	18 (11.0)	52 (3.9)	0.0003
Cardiac risk factors
Minor	46 (3.1)	10 (6.1)	36 (2.7)	0.0176
Major	44 (2.9)	5 (3.0)	39 (2.9)	0.9324
Severe	3 (0.2)	0 (0.0)	3 (0.2)	P = 0.5429
VUR disease severity
VUR Grade 1	40 (2.7)	7 (4.3)	33 (2.5)	0.1805
VUR Grade 2/3	446 (29.8)	50 (30.5)	396 (29.8)	0.8460
VUR Grade 4/5	887 (59.3)	95 (57.9)	792 (59.5)	0.6981
ASA classification
ASA Class 1	250 (16.7)	19 (11.6)	231 (17.4)	0.0618
ASA Class 2	1060 (70.9)	119 (72.6)	941 (70.7)	0.6204
ASA Class 3	177 (11.8)	25 (15.2)	152 (11.4)	0.1528
ASA Class 4	6 (0.4)	1 (0.6)	5 (0.4)	0.6547

¹The P value represents tests for significant variation from χ² analysis of categorical variables, t-test for continuous factors with equal variance.

VUR: Vesicoureteral reflux; ASA: American society of anesthesiology; VUR: Grade determined using standardized voiding cystourethrogram; ED: Emergency department.

Table 3 Postoperative outcomes for patients with an emergency department visit following ureteroneocystostomy, n (%)/mean ± SD

	Total cohort (n = 1495)	Postoperative ED visit (n = 164)	No postoperative ED visit (n = 1331)		P value1
Operative time
Total operation time (Minutes)	166.5 ± 74.3	181.8 ± 84.2		164.6 ± 72.9	0.0130
Length of hospital stay
Length of stay (Days)	20.3 ± 26.6	22.4 ± 43.0		20.1 ± 23.8	0.5042
Days from operation to discharge (Days)	1.8 ± 1.6	2.1 ± 2.10		1.7 ± 1.47	0.0220
Operative approach
Laparoscopic/MIS	189 (12.6)	16 (9.8)		173 (13.0)	0.2387
Open or N/A	1175 (78.6)	133 (81.1)		1042 (78.3)	0.4078
Laparoscopic/MIS and open	131 (8.8)	15 (9.1)		116 (8.7)	0.8539
Unilateral procedure	692 (46.3)	73 (48.5)		619 (46.5)	0.6392
Bilateral procedure	798 (53.4)	91 (55.5)		707 (53.1)	0.5993
SSI
Superficial incisional SSI	5 (0.3)	3 (1.8)		2 (0.2)	0.0110
Deep incisional SSI	1 (0.1)	1 (0.6)		0 (0.0)	0.1097
Organ space SSI	3 (0.2)	2 (1.2)		1 (0.1)	0.0033
Preoperative/intraoperative urine culture
No bacterial growth	791 (52.9)	82 (50.0)		709 (53.3)	0.4290
Bacterial growth, not UTI	111 (7.4)	14 (8.5)		97 (7.3)	0.5650
Bacterial growth, UTI	76 (5.1)	10 (6.1)		66 (5.0)	0.5311
Postoperative outcomes
Postoperative UTI	48 (3.2)	23 (14.0)		25 (1.9)	< 0.0001
Postoperative sepsis	9 (0.6)	6 (3.7)		3 (0.2)	< 0.0001
Postoperative septic shock	1 (0.1)	0 (0.0)		1 (0.1)	0.7256
Readmission	75 (5.0)	52 (31.7)		23 (1.7)	< 0.0001
Progressive renal insufficiency	5 (0.3)	2 (1.2)		3 (0.2)	0.0375
Unplanned reoperation	23 (1.5)	12 (7.3)		11 (0.8)	< 0.0001
Blood transfusion	4 (0.3)	2 (1.2)		2 (0.2)	0.0124
Ureteral stent/catheter	752 (50.3)	95 (57.9)		657 (49.4)	0.1410
Unplanned procedure related to anti-reflux procedure	36 (2.4)	22 (13.4)		14 (1.1)	< 0.0001
Unplanned urinary catheter (Intermittent or Indwelling)	45 (3.0)	29 (17.7)		16 (1.2)	< 0.0001

¹The P value represents tests for significant variation from χ² analysis of categorical variables, t-test for continuous factors with equal variance.

MIS: Minimally invasive surgery; SSI: Surgical site infection; UTI: Urinary tract Infection; ED: Emergency department.

Table 4 Logistic regression analysis of factors leading to postoperative emergency department visits

	Univariate analysis		Multivariate analysis
	OR (95% CI)	P value	OR (95% CI)	P value1
Patient characteristics
Hispanic ethnicity	1.06 (0.65-1.66)	0.818	1.18 (0.69-1.92)	0.529
Structural pulmonary abnormalities	2.33 (0.92-5.20)	0.052	2.60 (0.86-6.96)	0.087
Esophageal/gastric/intestinal disease	1.93 (1.04-3.38)	0.028	1.12 (0.46-2.52)	0.793
Ostomy	1.89 (0.97-3.42)	0.046	0.94 (0.36-2.22)	0.890
Postoperative variables and outcomes
Length of stay ≥ 20 days	4.05 (0.19-42.43)	0.254	1.87 (0.05-34.8)	0.704
Operative time ≥ 167 minutes	1.51 (1.09-2.09)	0.013	1.19 (0.82-1.71)	0.362
Postoperative urinary tract infection	8.52 (4.69-15.4)	<0.001	6.10 (2.93-12.4)	< 0.001
Postoperative sepsis	16.81 (4.39-80.3)	<0.001	3.28 (0.39-33.0)	0.272
Superficial incisional surgical site infection	12.38 (2.04-94.5)	0.006	12.3 (1.48-107)	0.022
Organ space surgical site infection	16.42 (1.56-355)	0.023	1.56 (0.06-58.3)	0.788
Progressive renal insufficiency	5.47 (0.72-33.2)	0.064	0.92 (0.06-11.4)	0.948
Blood transfusion	8.20 (0.98-68.8)	0.036	3.19 (0.13-214)	0.500
Unplanned procedure related to anti-reflux procedure	14.6 (7.37-29.8)	< 0.001	5.73 (2.15-15.3)	< 0.001
Unplanned urinary catheter (intermittent or indwelling)	17.7 (9.47-15.1)	< 0.001	8.81 (3.90-20.0)	< 0.001
Cardiac risk factors		0.153		0.107
None	Referent		Referent
Minor	2.34 (1.08-4.63)	0.021	1.57 (0.59-3.69)	0.333
Major	1.08 (0.37-2.54)	0.876	0.25 (0.05-0.98)	0.070
Prematurity		0.003		0.023
Full-term	Referent		Referent
25-30 completed weeks gestation	0.63 (0.03-3.18)	0.660	0.32 (0.02-2.00)	0.317
31-34 completed weeks gestation	1.61 (0.60-3.65)	0.292	1.21 (0.36-3.26)	0.734
35-36 completed weeks gestation	3.07 (1.70-5.30)	< 0.001	2.75 (1.39-5.18)	0.002

¹The P value represents tests for significant variation from univariate and multivariate analysis.