Page 17 - CUA 2020_Pediatric

2020 CUA Abstracts

MP-12.9 aimed to assess the clinical and economic relevance of single-use fURS,
Younger children undergoing ureteroscopic stone management specifically looking at low-volume use.
at higher risk of unplanned postoperative readmissions: An Methods: A literature search was performed until September 2018 in
analysis of the pediatric National Surgical Quality Improvement Medline (PubMmed), Embase, Cochrane Library, Centre for Reviews and
Program database Dissemination, as well as in the grey literature, in order to retrieve stud-
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Youshan Ding , Jacob Davidson , Ernest Chan , Jennifer Bjazevic , Guido ies on clinical efficacy safety and cost of single-use fURS. The US Food
Filler , Sumit Dave , Zhan Tao (Peter) Wang 1,5 and Drug Administration’s (FDA) Manufacturer and User Facility Device
1,5
4
1 Department of Surgery, Schulich School of Medicine & Dentistry, Experience (MAUDE) database was reviewed until September 20, 2018 to
Western University, London, ON, Canada; Division of Pediatric Surgery, supplement search on safety issue. Two reviewers independently performed
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Schulich School of Medicine & Dentistry, Western University, London, article selection, quality assessment, and data extraction. Disagreements
ON, Canada; Division of Urology, Schulich School of Medicine & were resolved with a third reviewer to achieve a consensus. The volume
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Dentistry, Western University, London, ON, Canada; Division of Pediatric of fURS performed during the financial period between May 28, 2017 to
Nephrology, Schulich School of Medicine & Dentistry, Western University, May 27, 2018 was estimated from hospital databases. Reported accidents
London, ON, Canada; Division of Pediatric Urology, Schulich School of were also retrieved from hospital database during this period.
5
Medicine & Dentistry, Western University, London, ON, Canada Results: Results from our review and two prospective studies suggested
Introduction: The incidence of pediatric urolithiasis has increased over that efficacy of single-use fURS for urinary lithiasis in adult population was
the last two decades. Ureteroscopy with laser lithotripsy (URS) is recom- similar to reusable fURS, without any published pediatric trial identified.
mended for the treatment of mid to distal ureteral calculi. However, there Two non-randomized prospective trials, two observational studies, and 13
is currently no consensus regarding whether URS is appropriate for all incident reports in adults were included. Most complications associated
pediatric patients. 1,2 with single-use fURS (6–17%) were similar to those known with reusable
Methods: A post-hoc analysis of data collected from the American College fURS (<15%). Five published economic studies were included using a
of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) cost-minimization approach. Global cost of single-use fURS was higher
pediatric version was performed. The ACS NSQIP pediatric datasets are than reusable fURS considering all aspects (purchase, repair, reprocessing,
validated and risk-adjusted and include 109 institutions across Canada and and sterilization). For the 328 adult interventions using fURS registered in
the U.S. to date. Outcomes of 299 865 pediatric patients between 2015 and 2017–2018 in our tertiary center, the breakage rate of our fURS was 6.4%,
2017 were examined. These children were identified using the International fixing the mean cost per intervention at $353 CAD based on purchase
Statistical Classification of Diseases and Related Health Problems (ICD) of five reusable fURS amortized over six years, repair, reprocessing, and
codes and by the Current Procedures Terminology (CPT) codes. sterilization costs. Results from our cost analysis according to breakage
Results: A total of 1122 pediatric URS cases were identified. The median avoidance scenario suggested that less than 10% of our ureteroscopy
age was 14.4 years and 55.4% of these cases were female. Overall, 8.9% should be performed with single-use fURS in our hospital to stay cost-
of URS cases required a readmission to hospital within 30 days of the effective. It also confirmed that a low-volume center (pediatric) using less
index procedure, and of these, 71% were unplanned readmissions. The than 11 single-use fURS per year was cost-effective.
two most common reasons for unplanned readmissions were postopera- Conclusions: This systematic review and economic analysis confirm that
tive urinary tract infections (UTIs, 26.4%) and persistent ureteral calculus single-use fURS is as effective as reusable fURS but should not be used for
(21.8%). On univariate analysis, children with unplanned readmissions every case in a large-volume center. Targeting its use for complex cases at
were significantly younger in age (median 11.3 years) compared to those higher risk of breakage, and in the setting of a low-volume center like our
without unplanned readmissions (median 14.5 years). The relative risk pediatric center is cost-effective. Further studies should be undertaken to
(RR) of an unplanned readmission was 2.4 times higher for children aged assess their effectiveness and cost-effectiveness during clinical interven-
6–11 years (95% confidence interval [CI] 1.51–3.93), and 4.5 times (95% tion in pediatric population.
CI 1.80–11.50) for children under two years old when compared to chil- References
dren 12–18 years old. 1. de la Rosette J, et al. The clinical research office of the endourologi-
Conclusions: This study found that younger children undergoing URS are cal society ureteroscopy global study: Indications, complications,
at a higher risk of unplanned readmissions secondary to postoperative and outcomes in 11 885 patients. J Endourol 2014;28:131-9. https://
UTI and persistent calculi. As such, age must be taken into account when doi.org/10.1089/end.2013.0436
deciding on the optimal surgical modality for children with urolithiasis. 2. Lechevallier E, Saussine C, Traxer O. [Ureteroscopy for upper urinary
Further prospective studies are needed to better elucidate the indications tract stones]. Prog Urol 2008;18:912-6. https://doi.org/10.1016/j.
of URS for pediatric urolithiasis. purol.2008.09.022
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MP-12.10 1030-x
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Catherine McMartin , Jonathan Cloutier , Stéphane J. Bolduc 2,3,4 7. https://doi.org/10.4103/0970-1591.44263
1 Urology, CHU de Québec-Université Laval, Quebec City, QC, 7. Reis Santos JM. Ureteroscopy from the recent past to the near
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City, QC, Canada; Axe Médecine Régénératrice, Centre de recherche- 8. Association canadienne d’urologie : Santé urologique, l’urétéroscopie.
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CHU de Québec-Université Laval, Quebec City, QC, Canada Available at: https://www.cua.org/themes/web/assets/files/patient_
Introduction: Ureteroscopes (URS), especially digital flexible URS (fURS), info/fr/43f-lroscopie_s.pdf. Accessed April 27, 2020.
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S154 CUAJ • June 2020 • Volume 14, Issue 6(Suppl2)