We performed an exploratory analysis of data from the National Spina Bifida Patient Registry (NSBPR) to assess variation in the frequency of bladder reconstruction surgeries among NSBPR centers.
We queried the 2009-2014 NSBPR to identify patients who had ever undergone bladder reconstruction surgeries. We evaluated demographic characteristics, SB type, functional level, mobility, and NSBPR center to determine whether any of these factors were associated with reconstructive surgery rates. Multivariable logistic regression was used to simultaneously adjust for the impact of these factors.
We identified 5,528 patients with SB enrolled in the NSBPR. Of these, 1,129 (20.4%) underwent bladder reconstruction (703 augmentation, 382 continent catheterizable channel, 189 bladder outlet procedure). Surgery patients were more likely to be older, female, non-Hispanic white, higher lesion level, myelomeningocele diagnosis, non-ambulators (all p<0.001) and non-privately insured (p=0.018). Bladder reconstruction surgery rates varied among NSBPR centers (range 12.1-37.9%, p<0.001). After correcting for known confounders, NSBPR center, SB type, mobility, gender and age (all p<0.001) were significant predictors of surgical intervention. Race (p=0.19) and insurance status (p=0.11) were not associated with surgical intervention.
There is significant variation in rates of bladder reconstruction surgery among NSBPR centers. In addition to clinical factors such as mobility status, lesion type, and lesion level, non-clinical factors such as patient age, gender and treating center are also associated with the likelihood of an individual undergoing bladder reconstruction.
The Journal of urology. 2017 Aug 19 [Epub ahead of print]
Jonathan C Routh, David B Joseph, Tiebin Liu, Michael S Schechter, Judy K Thibadeau, M Chad Wallis, Elisabeth A Ward, John S Wiener
Division of Urology, Duke University Medical Center, Durham, NC. Electronic address: ., Department of Urology, University of Alabama-Birmingham, Birmingham, AL., Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA., Division of Pediatric Pulmonary Medicine, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA., Division of Urology, Primary Children's Hospital, Salt Lake City, UT., Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA; Carter Consulting, Inc., Atlanta, GA., Division of Urology, Duke University Medical Center, Durham, NC.