- Email: [email protected]
MP54-12 DETERMINANTS OF PRACTICE PATTERNS IN PEDIATRIC UTI MANAGEMENT
THE JOURNAL OF UROLOGYâ
Vol. 193, No. 4S, Supplement, Sunday, May 17, 2015
Table 1 Characteristics of the patients with VUR according to obesity. Normal
Overweight
Obese
P-Value
No. of patients
41
16
15
-
Mean age(Mo.)
13.2
10.7
7
0.05
Male
32
12
15
Female
9
4
0
0
1
0
Gender
0.12
Hydronephrosis grade 1
0.563
2
0
0
0
3
11
4
3
4
19
5
7
5
11
6
5
Reflux grade
0.947
3
9
3
2
4
21
7
8
5
11
6
5
13136
20104
23858
<0.001
ESR(mm/h)
8.7
29.4
33.3
<0.001
CRP(mg/dL)
3.4
11.0
13.5
<0.001
Laboratory findings ^ 3) WBC count(/mmA
Surgical treatment
0.313
Yes
32
14
10
No
9
2
5
Renal scarring Absent
0.006 33
7
7
Focal
5
8
4
Multiple
3
1
3
Present
Source of Funding: none
MP54-11 READMISSION, UNPLANNED EMERGENCY ROOM VISITS, AND SURGICAL RETREATMENT RATES AFTER VESICOURETERAL REFLUX PROCEDURES Hsin-Hsiao Wang*, Rohit Tejwani, John Wiener, Jonathan Routh, Durham, NC INTRODUCTION AND OBJECTIVES: The choice between endoscopic injection (EI) and ureteroneocystotomy (UNC) for surgical correction of vesicoureteral reflux (VUR) is controversial. There is little data on VUR surgical outcomes from a population-level perspective. Our objective was to compare post-operative outcomes of both modalities using statewide datasets. METHODS: We reviewed the 2007-2010 CA, FL, NC, and UT State Ambulatory Surgery and Service Databases (SASD), State Emergency Department Databases (SEDD) and State Inpatient Databases (SID) to identify pediatric (<¼ 18y) VUR patients who received either EI or UNC as an initial surgical intervention. States were chosen solely due to data completeness. Patients with neurogenic bladder, ureterocele, megaureter, posterior urethral valves, bladder extrophy, kidney transplant, or prune belly syndrome were excluded. Unplanned readmissions, additional procedures, and ER visits were extracted. Statistical analysis was performed using multivariate logistic regression using GEE to adjust for hospital-level clustering. RESULTS: We identified 1,802 UNC and 1,768 EI procedures. Compared with patients underwent EI, patients who underwent UNC were more likely to be younger (4.8 v. 5.8 years, p<0.001), male (30 v. 22%, p<0.001), & publically insured (53 v. 50%, p<0.001). Compared with EI patients, UNC patients had a significantly lower rate of additional anti-reflux procedures within 12 months (19 (1.1%) v. 178 (10%), p<0.001) but a higher rate of 90-day readmissions (109 (6.0%)
e669
v. 42 (2.4%), p<0.001) and ER visits (263 (15%) v. 128 (7.2%), p<0.001). After adjusting for age, gender, insurance status, Charlson comorbidity score, treatment year, and hospital clustering, patients treated by UNC remained significantly more likely to be readmitted (OR¼2.74, p<0.001) and to have postoperative ER visits (OR¼2.12, p<0.001); however, patients treated by EI remained significantly more likely to undergo repeat anti-reflux procedures (OR¼12.48, p<0.001). CONCLUSIONS: Postoperative readmissions and ER visits were uncommon after any surgical intervention for VUR, but UNC was associated with 2-fold increased odds of readmission and postoperative ER visits. Strikingly, 10% of EI patients required retreatment; compared to UNC pts, this represents 12-fold increased odds of surgical retreatment. Source of Funding: Dr. Routh is supported by grant number K12-DK100024 from the National Institute of Diabetes and Digestive and Kidney Diseases
MP54-12 DETERMINANTS OF PRACTICE PATTERNS IN PEDIATRIC UTI MANAGEMENT Rachel Sharon Selekman*, Please choose an option below; Hillary L Copp, San Francisco, CA INTRODUCTION AND OBJECTIVES: The purpose of this study was to investigate practice patterns of and factors that influence urine testing and antibiogram use in the setting of empiric antibiotic treatment of urinary tract infection (UTI) in children. METHODS: We surveyed a random, cross-sectional, national sample of physicians caring for children from the American Medical Association Masterfile. Participants were queried regarding practice location and type, length of time in practice, factors influencing urine testing, urine specimen collection method, and antibiogram utilization. Logistic regression was used to assess factors associated with use of urine testing, bagged specimens, and antibiograms. RESULTS: Of respondents who acknowledged contact by surveyors 44% completed the survey. Most respondents (84%) obtain urinalysis and culture prior to treatment for UTI. Neither physician age (p ¼0.56) nor practice type (p ¼0.16) are associated with always ordering urine testing, though emergency physicians, pediatricians, and urologists are more likely to order testing compared with all other specialists (family practitioners, internists, adolescent specialists, and nephrologists), p ¼0.03. Physicians who do not always obtain urine testing report they would more likely order testing if the specimen were easier to collect (46%) and if results were available immediately (48%) by point of care testing. Urine collection by bag was more commonly performed in circumcised boys (>30%) compared with about 20% of girls and uncircumcised boys (p ¼0.02). The most common reasons for collection by bag were parental refusal for (49%) and difficulty with (42%) catheterization. Neither physician age (p ¼0.63) nor practice type (p ¼0.27) are associated with increased use of a collection bag, though urologists are less likely to use a collection bag (p ¼0.05) compared with all other specialists. Of 70% of respondents reporting antibiogram access, <50% report that they use an antibiogram the majority of the time with empiric prescription. Physician age, practice type, and specialty were not associated with antiobiogram use (p >0.05). CONCLUSIONS: While most practitioners follow guidelines to obtain urinalysis and culture prior to antibiotic prescription for UTI, urine collection by bag specimen is common, especially in circumcised males, and <50% of practitioners adhere to guideline recommendations for empiric antibiotic selection based on local antibiograms. Knowledge of these practice patterns can help direct interventions to improve adherence to UTI management guidelines. Source of Funding: None
Vol. 193, No. 4S, Supplement, Sunday, May 17, 2015
Table 1 Characteristics of the patients with VUR according to obesity. Normal
Overweight
Obese
P-Value
No. of patients
41
16
15
-
Mean age(Mo.)
13.2
10.7
7
0.05
Male
32
12
15
Female
9
4
0
0
1
0
Gender
0.12
Hydronephrosis grade 1
0.563
2
0
0
0
3
11
4
3
4
19
5
7
5
11
6
5
Reflux grade
0.947
3
9
3
2
4
21
7
8
5
11
6
5
13136
20104
23858
<0.001
ESR(mm/h)
8.7
29.4
33.3
<0.001
CRP(mg/dL)
3.4
11.0
13.5
<0.001
Laboratory findings ^ 3) WBC count(/mmA
Surgical treatment
0.313
Yes
32
14
10
No
9
2
5
Renal scarring Absent
0.006 33
7
7
Focal
5
8
4
Multiple
3
1
3
Present
Source of Funding: none
MP54-11 READMISSION, UNPLANNED EMERGENCY ROOM VISITS, AND SURGICAL RETREATMENT RATES AFTER VESICOURETERAL REFLUX PROCEDURES Hsin-Hsiao Wang*, Rohit Tejwani, John Wiener, Jonathan Routh, Durham, NC INTRODUCTION AND OBJECTIVES: The choice between endoscopic injection (EI) and ureteroneocystotomy (UNC) for surgical correction of vesicoureteral reflux (VUR) is controversial. There is little data on VUR surgical outcomes from a population-level perspective. Our objective was to compare post-operative outcomes of both modalities using statewide datasets. METHODS: We reviewed the 2007-2010 CA, FL, NC, and UT State Ambulatory Surgery and Service Databases (SASD), State Emergency Department Databases (SEDD) and State Inpatient Databases (SID) to identify pediatric (<¼ 18y) VUR patients who received either EI or UNC as an initial surgical intervention. States were chosen solely due to data completeness. Patients with neurogenic bladder, ureterocele, megaureter, posterior urethral valves, bladder extrophy, kidney transplant, or prune belly syndrome were excluded. Unplanned readmissions, additional procedures, and ER visits were extracted. Statistical analysis was performed using multivariate logistic regression using GEE to adjust for hospital-level clustering. RESULTS: We identified 1,802 UNC and 1,768 EI procedures. Compared with patients underwent EI, patients who underwent UNC were more likely to be younger (4.8 v. 5.8 years, p<0.001), male (30 v. 22%, p<0.001), & publically insured (53 v. 50%, p<0.001). Compared with EI patients, UNC patients had a significantly lower rate of additional anti-reflux procedures within 12 months (19 (1.1%) v. 178 (10%), p<0.001) but a higher rate of 90-day readmissions (109 (6.0%)
e669
v. 42 (2.4%), p<0.001) and ER visits (263 (15%) v. 128 (7.2%), p<0.001). After adjusting for age, gender, insurance status, Charlson comorbidity score, treatment year, and hospital clustering, patients treated by UNC remained significantly more likely to be readmitted (OR¼2.74, p<0.001) and to have postoperative ER visits (OR¼2.12, p<0.001); however, patients treated by EI remained significantly more likely to undergo repeat anti-reflux procedures (OR¼12.48, p<0.001). CONCLUSIONS: Postoperative readmissions and ER visits were uncommon after any surgical intervention for VUR, but UNC was associated with 2-fold increased odds of readmission and postoperative ER visits. Strikingly, 10% of EI patients required retreatment; compared to UNC pts, this represents 12-fold increased odds of surgical retreatment. Source of Funding: Dr. Routh is supported by grant number K12-DK100024 from the National Institute of Diabetes and Digestive and Kidney Diseases
MP54-12 DETERMINANTS OF PRACTICE PATTERNS IN PEDIATRIC UTI MANAGEMENT Rachel Sharon Selekman*, Please choose an option below; Hillary L Copp, San Francisco, CA INTRODUCTION AND OBJECTIVES: The purpose of this study was to investigate practice patterns of and factors that influence urine testing and antibiogram use in the setting of empiric antibiotic treatment of urinary tract infection (UTI) in children. METHODS: We surveyed a random, cross-sectional, national sample of physicians caring for children from the American Medical Association Masterfile. Participants were queried regarding practice location and type, length of time in practice, factors influencing urine testing, urine specimen collection method, and antibiogram utilization. Logistic regression was used to assess factors associated with use of urine testing, bagged specimens, and antibiograms. RESULTS: Of respondents who acknowledged contact by surveyors 44% completed the survey. Most respondents (84%) obtain urinalysis and culture prior to treatment for UTI. Neither physician age (p ¼0.56) nor practice type (p ¼0.16) are associated with always ordering urine testing, though emergency physicians, pediatricians, and urologists are more likely to order testing compared with all other specialists (family practitioners, internists, adolescent specialists, and nephrologists), p ¼0.03. Physicians who do not always obtain urine testing report they would more likely order testing if the specimen were easier to collect (46%) and if results were available immediately (48%) by point of care testing. Urine collection by bag was more commonly performed in circumcised boys (>30%) compared with about 20% of girls and uncircumcised boys (p ¼0.02). The most common reasons for collection by bag were parental refusal for (49%) and difficulty with (42%) catheterization. Neither physician age (p ¼0.63) nor practice type (p ¼0.27) are associated with increased use of a collection bag, though urologists are less likely to use a collection bag (p ¼0.05) compared with all other specialists. Of 70% of respondents reporting antibiogram access, <50% report that they use an antibiogram the majority of the time with empiric prescription. Physician age, practice type, and specialty were not associated with antiobiogram use (p >0.05). CONCLUSIONS: While most practitioners follow guidelines to obtain urinalysis and culture prior to antibiotic prescription for UTI, urine collection by bag specimen is common, especially in circumcised males, and <50% of practitioners adhere to guideline recommendations for empiric antibiotic selection based on local antibiograms. Knowledge of these practice patterns can help direct interventions to improve adherence to UTI management guidelines. Source of Funding: None