Perioperative complications within 30 days of hypospadias surgery: Results from NSQIP-Pediatrics

Does socioeconomic opportunity impact distal hypospadias surgical outcomes or post-operative care?

INTRODUCTION

Complications following hypospadias repair are common and several risk factors have been implicated such as penile biometrics and surgeon experience. Less well understood is that impact that social determinants of health have on hypospadias outcomes.

OBJECTIVE

Anatomic and technical factors have been identified that contribute to complications; however, the impact that social determinants of health have on outcomes remains unclear. We hypothesized that the development of complications following distal hypospadias repair in children is negatively associated with the presence of resources and conditions necessary for development.

METHODS

A retrospective analysis of children ≤18 years who underwent distal hypospadias repair from January 2016 to December 2022 was performed. Patients with <30 days follow-up were excluded from the primary analysis. The COI (Childhood Opportunity Index), calculated from residential address, was used as a measure of the resources and conditions present in a community necessary for healthy child development. The primary outcome was the presence of post-operative complications and the association of complications with COI. The secondary outcome was the association of COI and race with loss of follow-up (defined as no follow-up after 30 days post-operatively). Univariate and multivariable logistic regression analyses were used to assess the association of complications with COI, insurance status, anatomic, and technical factors.

RESULTS

938 patients were identified, of which 166 were lost to follow-up. The overall complication rate was 14.1%. There was no significant difference in COI, insurance type, race, or primary language between patients with and without complications (p > 0.05). Glans width, degree of chordee, and repair type were associated with complications on univariate regression analysis (p < 0.01) and glans width and degree of chordee were significant on multivariate analysis (p < 0.01). COI was not significant on univariate or multivariate analysis. Lower COI, non-white race, and government insurance were associated with lack of follow-up (p < 0.01) (Summary figure).

DISCUSSION

Socioeconomic opportunity is not an independent risk factor for complications after distal hypospadias repair; complications are impacted by anatomic factors and repair type. However, children with a lower COI were more likely to be lost to follow-up, and thus complications in this group may be underreported.

CONCLUSION

While socioeconomic opportunity does not appear to be a risk factor in the development of complications after distal hypospadias repair, non-white children and those with lower COI were more likely to be lost to follow-up and without proper follow-up this group has an unknown true complication rate.

Retrospective Study Over the Hypospadias Surgery in a Single Tertiary Center

Hypospadias surgery is a common activity in every department for pediatric surgery, increased incidence of this condition contributing this aspect. For this purpose permanent review of the data of cases is probably necessary, in order to promptly evaluate short and long term results.

MATERIAL AND METHODS

The authors are presenting this retrospective clinical and statistical study, enrolling 149 patients, hospitalized and operated in the Department of Pediatric Surgery and Orthopedics, between 2009 and 2018. several parameters were taken into consideration: moment of conception, type of hypospadias, associated malformations, use of meatoplasty, age at meatoplasty, age at urethroplasty, type of urethroplasty, postoperative incidents and complications.

RESULTS

Most of the patients included in the study were classified as anterior type of hypospadias, associated malformations were present in 20,13% of the patients, and 80% of the associated malformations belonged to the urogenital system. Over 60% of the cases underwent meatoplasty as a tactical procedure. Mathieu was the most appreciated procedure (74,5%) for urethroplasty and over a half of the patients were operated after the age of 3 years. Early and late postoperative fistula formation was noted in 18,12% of cases.

CONCLUSIONS

Better parameters to assess the exact type of hypospadias are needed to be introduced. Also, clear protocols for preoperative work-up in detection of other abnormalities, especially genito-urinary. Meatoplasty as a tactical procedure is having unclear influence for urethroplasty. Decreasing the age at urethroplasty should be the next goal. Some surgeons should really get overspecialized for this type of surgery.

Analysis of the social and clinical factors affecting the age of children when receiving surgery for hypospadias: a retrospective study of 1611 cases in a single center

We aimed to explore the associations between the age at which children undergo surgery for hypospadias and a range of social and clinical factors in a single center. Our aim was to promote the early surgical treatment of children with hypospadias. For a 6-year period, social and clinical data were collected from all children undergoing surgery to repair hypospadias in Children's Hospital of Chongqing Medical University (Chongqing, China), located in southwest of China. We analyzed the correlations between age at surgery and a range of social and clinical factors. A total of 1611 eligible cases were recruited, with a mean age of 54.3 months and a median age of 42 months: 234 cases (14.5%) were classified into a "timely operation" group, 419 (26.0%) cases into a "subtimely operation" group, and 958 (59.5%) cases into a "delayed operation" group. According to multivariate regression analyses, the higher the regional economic level, the closer the urethral opening to the perineum, and the higher the educational level of the guardians was, the younger the children were when they underwent the initial surgery for hypospadias; this was also the case for families without other children. Our subgroup analysis showed that the primary educational level of the guardians was a risk factor for subtimely surgery in their children (odds ratio [OR] = 1.52, 95% confidence interval [CI]: 1.08-2.15, P < 0.05). A lower regional economic level (OR = 1.87, 95% CI: 1.26-2.78, P < 0.01), a lower educational level of the guardians (OR = 3.84, 95% CI: 2.31-6.41, P < 0.01), and an anterior-segment urethral opening (OR₁ [vs middle hypospadias] = 2.07, 95% CI: 1.42-3.03; OR₂ [vs posterior hypospadias] = 2.63, 95% CI: 1.75-3.95; P < 0.01) were all risk factors for delayed surgery in children.