Comparing inpatient versus outpatient bowel preparation in children and adolescents undergoing appendicovesicostomy

David L. Weatherly, Konrad Szymanski, Benjamin Whittam, William E. Bennett, Shelly King, Rosalia Misseri, Martin Kaefer, Richard C. Rink, Mark P. Cain

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Purpose: The need for mechanical inpatient bowel preparation (IBP) in reconstructive pediatric urology has come under scrutiny, secondary to literature demonstrating little benefit regarding outcomes. Starting in 2013, a majority of patients undergoing reconstructive procedures at our institution no longer underwent IBP. We hypothesized that outpatient bowel preparation (OBP) would reduce length of stay (LOS) without increasing postoperative complications after appendicovesicostomy surgery. Materials and methods: An institutional database of patients undergoing lower urinary tract reconstruction between May 2010 and December 2014 was reviewed. Starting in 2013, a departmental decision was made to replace IBP with OBP. Patients undergoing an augmentation cystoplasty or continent ileovesicostomy were excluded because of insufficient numbers undergoing OBP. Patients undergoing IBP were admitted 1 day prior to surgery and received polyethylene glycol/electrolyte solution. A personalized preoperative OBP was introduced in 2013. Cost data were obtained from the Pediatric Health Information System. Results: Sixty-seven patients met the inclusion criteria, with 30 (44.8%) undergoing IBP. There were no differences with respect to gender, age, presence of ventriculoperitoneal shunt, body mass index, glomerular filtration rate, preoperative diagnosis, operative time, and prior or simultaneous associated surgeries (p ≥ 0.07). Patients undergoing an IBP had a longer median LOS (7 vs. 5 days, p = 0.0002) and a higher median cost (US$4,288, p = 0.01). Postoperative complications in both groups were uncommon and were classified as Clavien-Dindo grade 1-2, with no statistical difference (IBP 20.0% vs. OBP 5.4%, p = 0.13). No serious postoperative complication occurred, such as a dehiscence, bowel obstruction, or shunt infection. Discussion: This is the first analysis of hospitalization costs and IBP, showing a higher median cost of US$4288 compared with OBP. The LOS was shorter with an OBP (figure), similar to a previous report. Similar complication rates between the groups add to the growing body of literature that avoidance of IBP is safe in pediatric lower urinary tract reconstruction. Being a retrospective review of a practice change, differences in care that influenced cost and LOS may be missing. Also, as the surgeons do not know if a usable appendix is initially present, our data may not extrapolate to all patients. Despite these potential limitations, our data support the safety of utilizing OBP in patients with a high likelihood of a usable appendix, including those undergoing a synchronous Malone antegrade continence enema via a split-appendix technique. Conclusion: In patients undergoing an appendicovesicostomy, preoperative IBP led to longer LOS and higher costs of hospitalization. OBP was not associated with increased risks of postoperative complications.Display Omitted.

Original languageEnglish (US)
JournalJournal of Pediatric Urology
DOIs
StateAccepted/In press - 2017

Fingerprint

Inpatients
Outpatients
Length of Stay
Costs and Cost Analysis
Pediatrics
Urinary Tract
Hospitalization
Health Information Systems
Ventriculoperitoneal Shunt
Enema
Urology
Operative Time
Glomerular Filtration Rate
Electrolytes
Body Mass Index
Databases
Safety
Infection

Keywords

  • Appendicovesicostomy
  • Cost
  • Length of stay
  • Mechanical bowel preparation
  • Neurogenic bladder

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Urology

Cite this

Comparing inpatient versus outpatient bowel preparation in children and adolescents undergoing appendicovesicostomy. / Weatherly, David L.; Szymanski, Konrad; Whittam, Benjamin; Bennett, William E.; King, Shelly; Misseri, Rosalia; Kaefer, Martin; Rink, Richard C.; Cain, Mark P.

In: Journal of Pediatric Urology, 2017.

Research output: Contribution to journalArticle

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abstract = "Purpose: The need for mechanical inpatient bowel preparation (IBP) in reconstructive pediatric urology has come under scrutiny, secondary to literature demonstrating little benefit regarding outcomes. Starting in 2013, a majority of patients undergoing reconstructive procedures at our institution no longer underwent IBP. We hypothesized that outpatient bowel preparation (OBP) would reduce length of stay (LOS) without increasing postoperative complications after appendicovesicostomy surgery. Materials and methods: An institutional database of patients undergoing lower urinary tract reconstruction between May 2010 and December 2014 was reviewed. Starting in 2013, a departmental decision was made to replace IBP with OBP. Patients undergoing an augmentation cystoplasty or continent ileovesicostomy were excluded because of insufficient numbers undergoing OBP. Patients undergoing IBP were admitted 1 day prior to surgery and received polyethylene glycol/electrolyte solution. A personalized preoperative OBP was introduced in 2013. Cost data were obtained from the Pediatric Health Information System. Results: Sixty-seven patients met the inclusion criteria, with 30 (44.8{\%}) undergoing IBP. There were no differences with respect to gender, age, presence of ventriculoperitoneal shunt, body mass index, glomerular filtration rate, preoperative diagnosis, operative time, and prior or simultaneous associated surgeries (p ≥ 0.07). Patients undergoing an IBP had a longer median LOS (7 vs. 5 days, p = 0.0002) and a higher median cost (US$4,288, p = 0.01). Postoperative complications in both groups were uncommon and were classified as Clavien-Dindo grade 1-2, with no statistical difference (IBP 20.0{\%} vs. OBP 5.4{\%}, p = 0.13). No serious postoperative complication occurred, such as a dehiscence, bowel obstruction, or shunt infection. Discussion: This is the first analysis of hospitalization costs and IBP, showing a higher median cost of US$4288 compared with OBP. The LOS was shorter with an OBP (figure), similar to a previous report. Similar complication rates between the groups add to the growing body of literature that avoidance of IBP is safe in pediatric lower urinary tract reconstruction. Being a retrospective review of a practice change, differences in care that influenced cost and LOS may be missing. Also, as the surgeons do not know if a usable appendix is initially present, our data may not extrapolate to all patients. Despite these potential limitations, our data support the safety of utilizing OBP in patients with a high likelihood of a usable appendix, including those undergoing a synchronous Malone antegrade continence enema via a split-appendix technique. Conclusion: In patients undergoing an appendicovesicostomy, preoperative IBP led to longer LOS and higher costs of hospitalization. OBP was not associated with increased risks of postoperative complications.Display Omitted.",
keywords = "Appendicovesicostomy, Cost, Length of stay, Mechanical bowel preparation, Neurogenic bladder",
author = "Weatherly, {David L.} and Konrad Szymanski and Benjamin Whittam and Bennett, {William E.} and Shelly King and Rosalia Misseri and Martin Kaefer and Rink, {Richard C.} and Cain, {Mark P.}",
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AU - Weatherly, David L.

AU - Szymanski, Konrad

AU - Whittam, Benjamin

AU - Bennett, William E.

AU - King, Shelly

AU - Misseri, Rosalia

AU - Kaefer, Martin

AU - Rink, Richard C.

AU - Cain, Mark P.

PY - 2017

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KW - Appendicovesicostomy

KW - Cost

KW - Length of stay

KW - Mechanical bowel preparation

KW - Neurogenic bladder

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