460 INCIDENCE OF REPEAT DEXTRANOMER/HYALURONIC ACID COPOLYMER INJECTION AMONG PEDIATRIC HEALTH INFORMATION SYSTEM HOSPITALS

You have accessJournal of UrologyPediatrics: Congenital Anomalies - Kidney & Ureter1 Apr 2012460 INCIDENCE OF REPEAT DEXTRANOMER/HYALURONIC ACID COPOLYMER INJECTION AMONG PEDIATRIC HEALTH INFORMATION SYSTEM HOSPITALS Katherine Herbst, John Makari, Christina Kim, Fernando Ferrer, and Anthony Caldamone Katherine HerbstKatherine Herbst Hartford, CT More articles by this author , John MakariJohn Makari Hartford, CT More articles by this author , Christina KimChristina Kim Hartford, CT More articles by this author , Fernando FerrerFernando Ferrer Hartford, CT More articles by this author , and Anthony CaldamoneAnthony Caldamone Providence, RI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.528AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A recent systematic review reported a 77% aggregated success rate for Dextranomer/Hyaluronic Acid Copolymer Injection (Dx/HA) for treatment of vesicoureteral reflux (VUR). Although important, success rates are often not reflective of the level of the care that patient's receive. This study's objective was to determine how many children diagnosed with primary VUR and treated with Dx/HA undergo repeat Dx/HA injection. METHODS The Pediatric Health Information System (PHIS) database was searched for records with CPT Code 52327 billed between 1/1/2007 and 9/30/2009. Patients with prior Dx/HA or reimplant surgeries were excluded by reviewing records back to 2003. Patients with ICD-9 Dx codes suggestive of a diagnosis other than primary VUR were excluded. The resulting cohort was 2,739 patients from 23 hospitals. The database was then queried forward to 9/30/2010 and patients who received repeat Dx/HA injections identified. RESULTS The majority of the cohort were Caucasian females (84% and 85%, respectively), with a median age at intervention of 5.2 years, most (89%) receiving unilateral injection. Repeat Dx/HA occurred in 8% (225) of patients, with 0.4% (20) undergoing a third injection. Less than 1% (22) of patients had reimplantation. Follow up time ranged from 1 to 3 years. Among hospitals, rates of repeat Dx/HA varied from 0% to over 25% of patients (Fig 1). There was no correlation between volume of surgeries and incidence of repeat Dx/HA. CONCLUSIONS These results show that, not only is the incidence of repeat Dx/HA lower than expected given rates reported in the literature, wide variation exists in incidence of repeat injection among hospitals. This variation may be driven by many factors including VUR Grade at intervention, threshold for re-intervention, and frequency of follow-up VCUG testing. Currently, there are no rigorous studies that report evidence-based outcomes for this treatment. Collaborative randomized studies comparing VUR treatment options would assist in reducing unwanted variation. We hope that this data will spark a discussion among pediatric urologist to promote such studies. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e188 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Katherine Herbst Hartford, CT More articles by this author John Makari Hartford, CT More articles by this author Christina Kim Hartford, CT More articles by this author Fernando Ferrer Hartford, CT More articles by this author Anthony Caldamone Providence, RI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...