Details:

Alternative Title:
J Urol
Personal Author:
Wang, Hsin-Hsiao S. ; Lloyd, Jessica C. ; Wiener, John S. ; Routh, Jonathan C.
Wang, Hsin-Hsiao S. ; Lloyd, Jessica C. ; Wiener, John S. ; Routh, Jonathan C. Less -
Description:
Background

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.

Methods

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.

Results

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).

Conclusions

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.


Subjects:
[+]
Adolescent Article Child Child, Preschool Female Humans Infant Male Renal Insufficiency, Chronic Retrospective Studies Spinal Dysraphism Treatment Outcome Urinary Bladder, Neurogenic Urologic Surgical Procedures Young Adult
Source:
J Urol. 195(4 Pt 2):1189-1195.
Pubmed ID:
26926542
Pubmed Central ID:
PMC4826303
Document Type:
Journal Article
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 ; ... More +
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 Less -
Place as Subject:
United States
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:73fb2a1a973f83892480a4817e9b771839bd6032816c5b3242cb98cb32dfbec6
Download URL:
https://stacks.cdc.gov/view/cdc/40882/cdc_40882_DS1.pdf
File Type:

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