Introduction: Augmentation cystoplasty (AC) is a major urologic operation, and previous data suggest a high perioperative complication rate of approximately 30%; however, more contemporary data are lacking. We assessed clinical characteristics of patients undergoing AC as well as perioperative complication rates using a national database.
Methods: The Pediatric Health Information System (2004-2021) was queried to identify children (=21 years of age) who underwent AC using the appropriate International Classification of Diseases procedure code. Likewise, indication for AC, type of AC, and perioperative complications were identified. Multivariable logistic regression identified factors associated with the presence of at least one perioperative complication.
Results: 2596 patients were included. Baseline characteristics are detailed in Table 1. The most common indication for AC was spina bifida (50.9%). Small bowel cystoplasty was utilized in 56.7% of ACs, and a catheterizable stoma was created in 53.9% of ACs. 22.2% of patients had at least one perioperative complication; individual complication rates are given in Table 1. In multivariable regression, a primary indication of lower urinary tract obstruction (LUTO) was associated with a higher risk of complication (OR 2.18, 95% CI 1.20-3.87, p=0.009) as compared to spina bifida. Performance of small bowel cystoplasty (OR 1.29, 95% CI 1.04-1.60, p=0.02) or large bowel cystoplasty (OR 1.40, 95% CI 1.00-1.95, p=0.047) was associated with increased risk of perioperative complications, as compared to the absence of each respective procedure. Lastly, AC’s with catheterizable stoma creation were associated with a higher risk of perioperative complications (OR 1.26, 95% CI 1.04-1.53, p=0.02) as compared to AC’s without catheterizable stoma creation. Age, sex, race, year of AC, and ureterocystoplasty were unassociated with perioperative complications (p>0.05).
Conclusions: This population-level study provides contemporary data on the perioperative complication rate of AC and identifies LUTO as well as enterocystoplasty and concomitant channel creation as risk factors for perioperative complications.
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