Comparison of 30-day perioperative outcomes in adults undergoing open versus minimally invasive pyeloplasty for ureteropelvic junction obstruction: analysis of 593 patients in a prospective national database

PURPOSE: The surgical correction of ureteropelvic junction obstruction (UPJO) is indicated to prevent progression to chronic renal insufficiency. Minimally invasive surgery (MIS) has become increasingly popular as an approach to UPJO correction. We compared the perioperative outcomes between minimally invasive (MIP) and open pyeloplasty (OP) in the adult population.

METHODS: The current study was performed using the American College of Surgeons National Surgical Quality Improvement Program. Patients were identified using Current Procedural Terminology codes for pyeloplasty between 2005 and 2012, and were stratified according to either MIS or open approach. Patients with a diagnosis of malignant neoplasm of the kidney were excluded. Following exclusions, 593 patients remained for analysis. Primary outcomes of interest were overall perioperative complications, need for transfusions, re-intervention rate, prolonged operation time (pOT), prolonged length of stay (pLOS), readmission and mortality within 30 days of surgery. Multivariable logistic regression analyses were performed to examine the association between preoperative outcomes and surgical approach.

RESULTS: In this study, 423 (71.3 %) patients underwent MIP and 170 (28.7 %) underwent OP. Patients who underwent MIP had a decreased risk of wound [Odds ratio (OR) 0.06, p < 0.009] and overall complications (OR 0.21, p < 0.001), transfusions (OR 0.04, p = 0.004) and pLOS [pLOS (OR 0.08, p < 0.001)]. Conversely, MIP was associated with an increased likelihood of pOT (OR 2.26, p = 0.002).

CONCLUSION: Adults with UPJO undergoing MIP have a lower risk of overall complications, transfusions and pLOS compared to OP. Further studies are needed to determine whether these benefits offset the increase in expenditures, related to longer operative time and costs of disposables.