Joshua D. Roth

Readmission characteristics of elective pediatric circumcisions using large-scale administrative data

INTRODUCTION AND BACKGROUND Elective circumcision is a common procedure, known to be safe and associated with minimal morbidity. There are few data reporting the rates of readmission and reoperation following elective circumcision. OBJECTIVE We sought to define the rates of readmission and reoperation in the first 7 days following circumcision to accurately counsel families about the risks of this elective procedure. STUDY DESIGN The Pediatric Health Information System (PHIS) was interrogated from 2004 to 2013 for all ambulatory, elective circumcisions (ICD-9 CM code of 640). We assessed readmission with respect to age, insurance status, race, readmission diagnosis, time to readmission, and seasonal differences (due to higher rates of all-cause hospital admissions). We performed logistical regression analysis with a dependent variable of readmission within 7 days and independent variables of age, race, month of admission, and insurance status. RESULTS We identified 95,046 circumcisions from 2004 to 2013 performed in ambulatory surgery centers. Of those, 2906 (3.1%) of patients had an additional encounter at the same facility within 7 days. A total of 2409 (2.4%) of encounters were ER visits, and 253 (0.3%) were encounters for hospital admission or observation. One hundred and thirty-two patients (0.1%) underwent a second ambulatory procedure within the first 7 days following circumcision. Black patients (OR 1.26, p < 0.001) and patients on Medicaid (OR 1.63, p < 0.001) were more likely to seek care of any kind at the same institution within 7 days of the original circumcision operation. No difference was found with regard to time of year on logistic regression. Older age at circumcision was associated with increased likelihood of reoperation compared to children <1 year, with children 12-18 years old having an OR of 1.91 (p = 0.033). DISCUSSION We present a descriptive study of clinical events occurring at the same tertiary childrens hospital within the first 7 days following more than 95,000 elective postneonatal circumcisions. Limitations include a cohort generated from a single set of ICD-9 codes, and a follow-up of 7 days. CONCLUSION Elective circumcision remains a safe procedure with a readmission rate of 0.3%, and a reoperative rate of 0.1%. However, a relatively high percentage of patients (3.1%) will have a secondary encounter within the first 7 days following circumcision, most of them seeking care in an ER, although not necessarily for circumcision-related reasons. These may be useful data when counseling patients.

Long-Term Sequela of Pediatric Bladder Reconstruction

Children with refractory neurogenic bladder (NGB) who have failed maximal medical management are presented with options for bladder reconstruction. It is critical to understand the long-term sequela of bladder augmentation and bladder neck reconstruction to properly counsel families regarding these procedures. Benefits may include preservation of renal function, continence, reduced risk of renal-related mortality, and potential improvements in quality of life (QOL). However, these advantages must be balanced with the risks of bladder calculi, perforation, need for additional surgery, acid/base disturbances, vitamin B12 deficiency, and malignancy. Therefore, careful patient selection and preoperative counseling are paramount for those undergoing bladder reconstruction which includes intestinal bladder augmentation, as these patients require lifelong vigilant follow-up.

An ovulating follicle presenting as a testicular mass in a teenage patient with ovotesticular DSD

Disorders of sexual differentiation (DSD) occur when an incongruity exists between a childs external genitalia, gonadal histology and chromosomal sex. Ovotesticular DSD (ODSD) represents 5% of DSD.1 In an ovotestis, the testis is always central and the ovary polar. There are three anatomic variants: • Bilateral: Testis and ovary bilaterally, either separate or united as an ovotestis (30%) • Unilateral: Testis or ovary on one side and a contralateral ovotestis (50%) • Lateral/Alternating: Testis and contralateral ovary (20%)1,2 We report a child with histologically documented Alternating ODSD who was later reclassified as having Unilateral ODSD after an ovarian remnant produced a corpus luteum cyst.

Characteristics of Female Genital Restoration Surgery for Congenital Adrenal Hyperplasia Using a Large Scale Administrative Database

OBJECTIVE To analyze nationwide information on the timing of surgical procedures, cost of surgery, hospital length of stay following surgery, and surgical complications of female genital restoration surgery (FGRS) in females with congenital adrenal hyperplasia (CAH). MATERIALS AND METHODS We used the Pediatric Health Information System database to identify patients with CAH who underwent their initial FGRS in 2004-2014. These patients were identified by an International Classification of Diseases, Ninth Revision (ICD-9) diagnosis code for adrenogenital disorders (255.2) in addition to a vaginal ICD-9 procedure code (70.x, excluding vaginoscopy only) or perineal ICD-9 procedure code (71.x), which includes clitoral operations (71.4). RESULTS A total of 544 (11.8%) females underwent FGRS between 2004 and 2014. Median age at initial surgery was 9.9 months (interquartile range 6.8-19.1 months). Ninety-two percent underwent a vaginal procedure, 48% underwent a clitoral procedure, and 85% underwent a perineal procedure (non-clitoral). The mean length of stay was 2.5 days (standard deviation 2.5 days). The mean cost of care was

Neuropathic Bladder and Augmentation Cystoplasty

12,258 (median

Mobility, hydrocephalus and quality of erections in men with spina bifida

9,558). Thirty-day readmission rate was 13.8%. Two percent underwent reoperation before discharge, and 1 (0.2%) was readmitted for a reoperation within 30 days. Four percent had a perioperative surgical complication. CONCLUSION Overall, 12% of girls with CAH underwent FGRS at one of a national collaborative of freestanding childrens hospitals. The majority underwent a vaginoplasty as a part of their initial FGRS for CAH. Clitoroplasty was performed on less than half the patients. Overall, FGRS for CAH is performed at a median age of 10 months and has low 30-day complication and immediate reoperation rates.

PD48-01 URINARY AND FECAL INCONTINENCE DURING SEXUAL ACTIVITY IS COMMON AND BOTHERSOME AMONG ADULTS WITH SPINA BIFIDA

Surgical indications for individuals with neuropathic bladder include unsafe urinary storage pressures, progressive upper tract deterioration, and continued urinary incontinence that is recalcitrant to oral pharmacologic or intradetrusor injection therapy and intermittent catheterization. Bladder augmentation is currently the gold standard surgical procedure used to increase bladder capacity and reduce storage pressures but has significant long-term risks. The medical and surgical management of neuropathic bladder, as well as long-term consequences of bladder augmentation, are reviewed.