A Contemporary Analysis of Ureteral Reconstruction 30-Day Morbidity Utilizing the National Surgical Quality Improvement Program Database: Comparison of Minimally Invasive vs Open Approaches

Abstract

Objectives: To characterize 30-day morbidity of upper ureteral reconstruction (UUR) and lower ureteral reconstruction (LUR) surgery by comparing open and minimally invasive surgery (MIS) approaches using a national surgical outcomes registry. Methods: The American College of Surgeons National Surgical Quality Improvement Program database was reviewed for patients who underwent UUR and LUR between 2007 and 2017. Primary endpoints included 30-day complications, transfusion, readmission, return to operating room (ROR), and prolonged postoperative length of stay (LOS). Multivariable logistic regression was performed to observe the association of MIS approach on 30-day outcomes. Results: Three thousand forty-two patients were identified with 2116 undergoing UUR and 926 undergoing LUR. Of 2116 patients undergoing UUR, 1733 (82%) were performed through an MIS approach. On multivariable analysis, open approach for UUR was associated with increased odds of any 30-day complication (odds ratio (OR) 1.6 [1.1-2.4]; p = 0.014), major complication (OR 1.8 [1.04-3.0]; p = 0.034), transfusion (OR 3.7 [1.2-11.5]; p = 0.025), ROR (OR 2.0 [1.0-3.9]; p = 0.047), and prolonged LOS (OR 5.4 [3.9-7.6]; p < 0.001). Of the 926 patients undergoing LUR, 458 (49%) were performed through an MIS approach. On multivariable analysis, open approach for LUR was associated with increased odds of any 30-day complication (OR 1.5 [1.1-2.1]; p = 0.028), minor complication (OR 1.7 [1.1-2.6]; p = 0.02), transfusion (OR 8.1 [2.7-23.7]; p < 0.001), and prolonged LOS (OR 4.2 [2.4-7.3]; p < 0.001). Conclusion: Utilization of a national surgical database revealed an open approach was associated with increased 30-day morbidity across multiple postoperative outcome measures. These findings suggest an MIS approach should be considered, when feasible, for upper and lower ureteral reconstruction.

Keywords: NSQIP database; laparoscopy; minimally invasive surgery; robotic surgery; ureteral reconstruction; ureteral stricture.