Nationwide Trends and Variations in Urologic Surgical Interventions and Renal Outcome for Spina Bifida patients
Published Date:Feb 28 2016
Source:J Urol. 195(4 Pt 2):1189-1195.
Clinical Care Variation
Renal Insufficiency, Chronic
Urinary Bladder, Neurogenic
Urologic Surgical Procedures
Pubmed Central ID:PMC4826303
Funding:U01-DD001082/DD/NCBDD CDC HHS/United States
U01 DD001082/DD/NCBDD CDC HHS/United States
K08 DK100534/DK/NIDDK NIH HHS/United States
K08-DK100534/DK/NIDDK NIH HHS/United States
U01-DD001087/DD/NCBDD CDC HHS/United States
U01 DD001087/DD/NCBDD CDC HHS/United States
Bladder dysfunction in spina bifida (SB) patients can lead to significant morbidity due to renal insufficiency. Indications for surgery vary between institutions, and the impact is unclear. Our objective was to examine trends and variations in urologic interventions and chronic renal insufficiency in SB patients.
We reviewed the Nationwide Inpatient Sample (NIS) for all SB patients treated from 1998–2011. We used ICD-9-CM codes to identify urologic surgery and chronic renal insufficiency (CRI). We calculated Spearman’s correlation coefficients between rates of SB-related bladder surgeries and rates of CRI outcomes by state. Linear regression models were fitted to investigate the associations between rates of SB-related surgery and CRI across treatment years.
We identified 427,616 SB admissions (mean age 26y, 56% female); 35,249(8%) were for CRI and 11,078 (3%) were for surgery. Over the study period, CRI rates doubled (6–12%) and surgery rates declined (2.0–1.8%). There was a moderately weak, inverse association between surgery and CRI rates over time (r=−0.3, p=0.06) and by state (r=−0.3, p=0.04). On multivariate analysis, higher rates of surgery were associated with the state in which the patient was treated (p<0.001), younger age (p<0.001), and hospital teaching status (p<0.001). In contrast, CRI was not associated with SB-related surgery (p=0.67).
We observed a temporal and geographic trend toward decreasing urologic surgery and increasing CRI rates in SB and a wide variation in urologic surgical rates among states. Further study is needed to determine the factors behind these trends and variations in SB management.
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