IN BRIEF

Multicenter Data Reveals Distal Hypospadias Repair Overall Success Rate

October 29, 2019

Despite its use as an indicator of a department’s surgical skill, the reoperation rate for distal hypospadias repair has long been based on publications covering data from single-center studies — until now.

Among its indicators for urologic surgery quality, U.S. News & World Report examines the complication rate for children undergoing distal hypospadias repair (relocation of the urethral opening from another area on the head or shaft of the penis to its normal location at the tip). The problem with this approach, however, is that prior publications reporting outcomes for these surgeries used data from single physicians or single centers. This made it hard to determine how representative the data were and left physicians telling parents what to expect based on the performance of a few isolated clinicians.

That’s why physician-researcher Daniel DaJusta, MD, a pediatric urologist at Nationwide Children’s Hospital, worked with colleagues to illuminate the operation’s overall success rate by studying data from the State Ambulatory Surgery and Services Databases of nine states. Their recent publication in the Journal of Pediatric Urology reports what is believed to be the first multi-institutional analysis of reoperation for distal hypospadias repair.

“Surgeons cannot extrapolate one person’s experience and performance to their own,” says Dr. DaJusta, who is also a clinical assistant professor of Urology at The Ohio State University College of Medicine. “The idea was to verify if surgeons across the country were achieving similar results or if there is a lot of variation, and large data sets are the best way to establish a reasonable measure of success.”  

The study examined data on 4,673 children ages 0-18, across 148 institutions. The team retrospectively followed the cohort of patients, who all underwent their initial operation in 2008-2013. During the follow-up period (ranging 2-7.9 years), 2.6% of children underwent reoperation in the first year, and a total of 6.7% underwent reoperation within 5 years.

The researchers examined possible predictors for reoperation, such as age, race/ethnicity, institutional volume of the procedure, facility ownership and patient health insurance status — none of which significantly impacted reoperation risk. The databases do not contain what urologists believe may be more probable predictors of complications and reoperation, such as penile size or complexity of the repair.

“Overall, the success rate is about 93%. This likely varies a bit up or down based on surgeon experience and patient characteristics, but this now allows doctors to set a good expectation for their own performance,” says Dr. DaJusta. “It also gives a starting point to use in discussions with parents and patients about the risks and benefits of surgery — having good information to counsel them with is paramount.”

Dr. DaJusta believes the more representative success rate will be helpful for centers that do not track their own data, and that it could help level-set the field for outcomes reporting and national rankings. He and his colleagues continue to examine surgical success rates and techniques for children with a wide range of urological conditions in an effort to improve outcomes.

Reference:

Sebastião YV, Brown CT, Cooper JN, McLeod DJ, DaJusta DG. Risk of re-operation after outpatient distal hypospadias repair in a large, multistate cohort. Journal of Pediatric Urology. 2019 Jun 22. [Epub ahead of print]

Image credit: Nationwide Children’s