Open versus minimally invasive ureteroneocystostomy: A population-level analysis

Strengths of this study are its large cohort size, long time horizon, national estimation, and cost data. Most prior studies are case-series limited to the size of the institutional cohort. Our analysis of 76,756 operative encounters revealed that open UNC continues to be performed at far greater frequency than MIS UNC, outpacing the latter modality by nearly 100:1. Children treated with MIS UNC had three times greater odds of developing postoperative urinary complications, and MIS UNC patients incurred average costs per admission that were nearly 1.5 times higher than those of children who underwent open UNC. These children were also likely to be older, publically insured, and treated in more recent years. On the other hand, patients treated with MIS UNC required substantially shorter postoperative hospitalization, with an average LOS roughly half that of open UNC cases. Limitations include the retrospective nature of the administrative database, lack of detailed patient-level data, and no available long-term postoperative outcomes. Compared with open surgery, MIS UNC was associated with shorter LOS but higher costs and possibly higher urinary complication rates.Table. Bivariate/multivariate analysis of postoperative complications for MIS UNC.NSQIP complicationsaUnadjusted OR (95% CI)Adjusted ORb (95% CI)p valuebUTI1.00 (0.37-2.72)0.99 (0.40-2.44)0.98Urinary complications2.63 (1.00-6.91)3.13 (1.17-8.40)0.02All complications1.15 (0.48-2.78)1.27 (0.57-2.85)0.56aUsing open UNC as reference.bAfter adjusting for age, gender, insurance, year, comorbidity, teaching status, hospital region, and hospital size.