ORLANDO, FL USA (UroToday.com) - An interesting presentation used the Pediatric Health Information System (PHIS) database to compare the volume and outcomes of all-cause nephrectomies at freestanding children’s hospitals by pediatric urologists and general pediatric surgeons. Nephrectomy (and partial nephrectomy) typically falls under the purview of adult urologists, and is specifically included in graduation requirements outlined by the ACGME for residents and fellows. In contrast, general surgery residency and pediatric surgery fellowship programs do not necessarily specify nephrectomy as an isolated experience; it typically is included in a list of multiple oncologic requirements.
The PHIS database was queried to identify all patients who underwent a nephrectomy between 1/1/2004 and 6/30/2013, and various data points were compared between children who underwent nephrectomy by pediatric urology versus pediatric general surgery. Pediatric urologists perform more all-cause nephrectomies, especially partial nephrectomies. General pediatric surgeons were more likely to operate on children with malignancy (likely reflecting long-standing referral patterns), and transplant nephrectomies. Urology operated on younger children, with a slight male predominance; general surgery operated on children who with higher severity levels and risk of mortality. When controlling for age, gender, severity level, risk of mortality, and renal/malignancy flags, children operated on by pediatric urology had a shorter length of stay and fewer complications.
Urologists have to demonstrate competency in renal surgery techniques as a fundamental part of their residency training. Thus, oncology cases should be referred more often to pediatric urologists, especially if nephron-sparing surgery is an option. These results are subject to the usual limitations of secondary data analysis but clearly show that pediatric urologists have a low incidence of complications associated with nephrectomy. Hopefully, referral patterns will start to reflect awareness of this unique expertise as data such as this is published and promoted.
Presented by Kristina D. Suson, MD at the Society for Pediatric Urology (SPU) Annual Meeting held concurrently with the American Urological Association (AUA) Annual Meeting - May 16 - 21, 2014 - Orlando, Florida USA
Children’s Hospital of Michigan, Detroit, MI USA
Written by Michaella Prasad, MD of the Medical University of South Carolina, Charleston, and medical writer for UroToday.com