Rohit Tejwani

Hospital Surgical Volume and Associated Postoperative Complications of Pediatric Urological Surgery in the United States

PURPOSE Hospital and provider surgical volume have been increasingly linked to surgical outcomes. However, this topic has rarely been addressed in children. We investigated whether hospital surgical volume impacts complication rates in pediatric urology. MATERIALS AND METHODS We retrospectively reviewed the Nationwide Inpatient Sample (1998 to 2011) for pediatric (18 years or younger) hospitalizations for urological procedures. We used ICD-9-CM codes to identify elective urological interventions and NSQIP® postoperative in hospital complications. Annual hospital surgical volume was calculated and dichotomized as high volume (90th percentile or above) or non-high volume (below 90th percentile). RESULTS We identified 158,805 urological admissions (114,634 high volume and 44,171 non-high volume hospitals). Of the hospitals 75% recorded fewer than 5 major pediatric urology cases performed yearly. High volume hospitals showed treatment of significantly younger patients (mean 5.4 vs 9.6 years, p < 0.001) and were more likely to be teaching hospitals (93% vs 71%, p < 0.001). The overall rate of NSQIP identified postoperative complications was higher at non-high volume vs high volume hospitals (11.6% vs 9.3%, p = 0.003). After adjusting for confounding effects patients treated at non-high volume hospitals remained more likely to suffer multiple NSQIP tracked postoperative complications, including acute renal failure (OR 1.4, p = 0.04), urinary tract infection (OR 1.3, p = 0.01), postoperative respiratory complications (OR 1.5, p = 0.01), systemic sepsis (OR 2.0, p ≤ 0.001), postoperative bleeding (OR 2.5, p < 0.001) and in hospital death (OR 2.2, p = 0.007). CONCLUSIONS Urological procedures performed in children at non-high volume hospitals were associated with an increased risk of in hospital, NSQIP identified postoperative complications, including a small but significant increase in postoperative mortality, mostly following nephrectomy and percutaneous nephrolithotomy.

Is the Economic Impact and Utilization of Imaging Studies for Pediatric Urolithiasis Across the United States Increasing

OBJECTIVE To identify longitudinal trends of economic impact and resource utilization for management of pediatric urolithiasis using national databases. METHODS We analyzed the 2006-2012 Nationwide Emergency Department Sample and Nationwide Inpatient Sample. We used ICD-9 (International Classification of Diseases) codes to identify patients (≤18 years) diagnosed with urolithiasis. Diagnostic imaging and surgeries were identified using ICD-9 and Current Procedural Technology codes. We abstracted demographic, imaging, procedure, and charge data. Weighted descriptive statistics were calculated to describe the populations demographics and economic expenditures by clinical setting and year. RESULTS In total, 45,333 inpatient admissions (68% females) and 234,559 emergency department encounters (63% females) were identified. Most patients (84%) were teenagers and the southern region of the United States was the most common geographic region for all encounters (44%). There was no significant trend in number of urolithiasis encounters over the period studied. Utilization of all imaging techniques increased; in particular, computed tomography was used in 23% of encounters in 2006 and 40% in 2012 (P < .0001). The mean charge per emergency department visit increased by 60% from

Utility Estimation for Pediatric Vesicoureteral Reflux: Methodological Considerations Using an Online Survey Platform.

3645 in 2006 to

Open versus minimally invasive ureteroneocystostomy: A population-level analysis

5827 in 2012 (P < .0001). The mean charge increased for inpatient admissions by 102%, from

Increased pediatric sub-specialization is associated with decreased surgical complication rates for inpatient pediatric urology procedures

16,399 in 2006 to

Outcomes of Shock Wave Lithotripsy and Ureteroscopy for Treatment of Pediatric Urolithiasis

33,205 in 2012 (P < .0001). Total charges increased 72% over the study period from

Open versus minimally invasive surgical approaches in pediatric urology: Trends in utilization and complications

230 million in 2006 to

Crowdsourcing utility estimation for spina bifida in the general population

395 million in 2012 (P < .0001), outpacing medical inflation over the same period. CONCLUSION Charges for pediatric urolithiasis management increased by 65% from 2006 to 2012 despite stable frequency of patient encounters. The utilization of computerized tomography in pediatric urolithiasis increased as well.

Readmissions, unplanned emergency room visits, and surgical retreatment rates after anti-reflux procedures ☆

Purpose: The advent of online task distribution has opened a new avenue for efficiently gathering community perspectives needed for utility estimation. Methodological consensus for estimating pediatric utilities is lacking, with disagreement over whom to sample, what perspective to use (patient vs parent) and whether instrument induced anchoring bias is significant. We evaluated what methodological factors potentially impact utility estimates for vesicoureteral reflux. Materials and Methods: Cross‐sectional surveys using a time trade‐off instrument were conducted via the Amazon Mechanical Turk® (https://www.mturk.com) online interface. Respondents were randomized to answer questions from child, parent or dyad perspectives on the utility of a vesicoureteral reflux health state and 1 of 3 “warm‐up” scenarios (paralysis, common cold, none) before a vesicoureteral reflux scenario. Utility estimates and potential predictors were fitted to a generalized linear model to determine what factors most impacted utilities. Results: A total of 1,627 responses were obtained. Mean respondent age was 34.9 years. Of the respondents 48% were female, 38% were married and 44% had children. Utility values were uninfluenced by child/personal vesicoureteral reflux/urinary tract infection history, income or race. Utilities were affected by perspective and were higher in the child group (34% lower in parent vs child, p <0.001, and 13% lower in dyad vs child, p <0.001). Vesicoureteral reflux utility was not significantly affected by the presence or type of time trade‐off warm‐up scenario (p = 0.17). Conclusions: Time trade‐off perspective affects utilities when estimated via an online interface. However, utilities are unaffected by the presence, type or absence of warm‐up scenarios. These findings could have significant methodological implications for future utility elicitations regarding other pediatric conditions.