Introduction: The strength of the evidence base supporting surgical management of urinary stone disease for pediatric patients is weak. Using data from the PKIDS Network, we aimed to describe characteristics of institutions and surgeons in PKIDS and factors associated with selection of surgical intervention modality for different clinical scenarios. Methods: Surgeons in the PKIDS Network completed intake surveys at site activation between February 2020 and September 2022. Surgeon questionnaires collected demographics, clinical and surgical management preferences. Institutional questionnaires collected site characteristics about case volume, equipment availability, and infrastructure. Assessment of preference between surgery type (URS, SWL, PCNL) was evaluated using 4 different clinical scenarios included in the surgeon survey (A) 2 cm kidney stone, B) 9 mm proximal ureteral stone, C) 1.5 cm lower pole kidney stone, D) 1 cm non lower pole kidney stone. Four multivariable linear regression models were built to evaluate the association between surgeon and institutional characteristics and the choice of surgical intervention for each of the 4 clinical scenarios. Principal component analysis was performed to identify clusters of characteristics that influenced surgical intervention. Results: A total of 31 sites and 148 surgeons with a mean of 9.7 years in practice (SD=8.7 years) completed surveys. There was wide variation in surgeon preferences for type of surgical intervention; equipoise was greatest for URS versus PCNL for a 1.5cm kidney stone (Figure 1). Principal component analysis identified 3 clusters of factors influencing surgeon preferences: A. Stone characteristics (size, location, and density), B. Patient characteristics (symptoms, history of urinary tract infections, comorbidities, and prior surgical history) and C. Other (complications, reimbursement, radiation exposure and number of anesthetics). Conclusions: Wide heterogeneity in the characteristics and preferences of surgeons who surgically manage pediatric patients with urinary stones was identified. A cohort of surgeons expressed preference for surgical modality driven primarily by kidney stone features, another by patient features, and a third by other variables. SOURCE OF Funding: Patient Centered Outcomes Research Institute (PECORI)
