Evidence of variation by race in the timing of surgery for correction of pediatric ureteropelvic junction obstruction.

摘要

PURPOSE: We used a national pediatric database to investigate the association of patient race with timing of surgery for ureteropelvic junction obstruction. MATERIALS AND METHODS: The Kids' Inpatient Database is a national database containing 5.5 million pediatric hospitalizations (patients younger than 21 years) during the years 2000 to 2003. We used International Classification of Disease-9 codes to identify patients undergoing pyeloplasty, and investigated patient and hospital factors associated with timing of surgery using multivariable linear and mixed models. RESULTS: A total of 2,989 patients underwent pyeloplasty. Mean patient age was 72.3 months (median 36). Of the patients 69.3% were male and 66.0% were white. White patients were significantly older than nonwhite patients (82.3 vs 52.8 months, p <0.0001). The proportion of patients undergoing surgery during the first 12 months of life also varied by race (31.3% among white vs 46.9% among nonwhite patients, p <0.0001). Other factors associatedwith younger age included male gender (p = 0.0002), hospital volume and teaching status (p <0.0001), and Medicaid insurance (p <0.0001). Socioeconomic status at the zip code level was not associated with timing of surgery. Using a multivariable mixed model to adjust for all variables, including random effects of individual hospitals, nonwhite race was still associated with earlier surgery (p = <0.0001). CONCLUSIONS: This study confirms that nonwhite patients undergo pyeloplasty an average of more than 2.5 years earlier than white patients (even after adjusting for insurance status and other factors). Future research should elucidate the clinical factors that influence surgical decision making in ureteropelvic junction obstruction, including socioeconomic and cultural factors among families and providers, as well as possible biological differences between racial groups in the natural history of ureteropelvic junction obstruction.