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Complications of delayed and newborn primary closures of classic bladder exstrophy: Is there a difference?

Published:January 04, 2023DOI:https://doi.org/10.1016/j.jpurol.2023.01.001

      Summary

      Introduction

      The authors aim to compare single institutional 30-day complication rates between delayed and neonatal closure of classic bladder exstrophy (CBE).

      Materials and methods

      An institutional database of 1415 exstrophy-epispadias patients was reviewed retrospectively for CBE patients who underwent primary closures at the authors' institution between 1990 and 2020. Patients were identified as having received either neonatal or delayed (at age >28 days) closures. All 30-day complications were recorded, including wound infection and dehiscence, genitourinary and non-genitourinary infections, bowel obstruction, blood transfusions, and others. Descriptive statistics were performed to summarize patient level data. Categorical variables were reported by count and percentages and were compared using Exact Cochran-Armitage trend analysis by decade, or with Fisher's Exact Test and Chi-square test when directly comparing categories and outcomes. Continuous variables were analyzed via Mann Whitney U and one-way ANOVA as appropriate.

      Results

      The cohort included 145 patients: 50 delayed and 95 neonatal closures. The total complication rate was 58% in delayed closures compared to 48.4% for neonatal closures (p = 0.298), with the majority being Clavien-Dindo grade I or II. Excluding blood transfusion, complication rates fell to 26% and 34.7% in delayed and neonatal closures, respectively (p = 0.349). The most common single complication was unplanned post-operative blood transfusion (38% delayed; 26.3% neonatal; p = 0.34), followed by pyelonephritis (2% delayed; 8.4% neonatal), and urinary fistula (6% delayed; 1.1% neonatal). Grade III Clavien-Dindo complications occurred in 2% delayed and 7.4% neonatal groups (n = 1; n = 7 respectively; p = 0.263). A single delayed patient had grade IV complications compared to three neonatal patients (p = 0.66).

      Conclusions

      Summary Table30-day post-operative complications.
      Variable, n (%) Neonatal Delayed P
      Any complication 46 (48.4%) 29 (58%) 0.298
      Complication w/o Transfusion 33 (34.7%) 13 (26%) 0.349
      Clavien I-II complications 40 (42.1%) 27 (54%) 0.292
      Wound dehiscence 2 (2.1%)
      Wound infection 1 (1%) 1 (2%)
      Febrile UTI 5 (5.3%) 1 (2%)
      Pyelonephritis 8 (8.4%) 1 (2%)
      Urinary fistula 1 (1%) 3 (6%)
      Non-GU infection 2 (2.1%) 3 (6%)
      Other 5 (5.3%) 2 (4%)
      Post-operative Transfusion 25 (26.3%) 19 (38%) 0.34
      Clavien III complications 7 (7.4%) 1 (2%) 0.263
      Wound dehiscence 3 (3.2%)
       Wound infection
      Urinary fistula
      Bowel obstruction 1 (2%)
      Non-GU infection 1 (1%)
      Other 3 (3.2%)
      Clavien IV complications 3 (3.2%) 1 (2%) 1
      Non-GU infection 1 (1%) 1 (2%)
      Other 2 (2%)

      Keywords

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