To determine the patient and surgical factors that contribute to 30 days morbidity after pediatric pyeloplasty using a national database.

This retrospective cohort study used the National Surgical Quality Improvement Program Pediatrics (NSQIP-P) database to evaluate factors associated with 30 days post-surgical outcomes in pediatric patients who had undergone open and laparoscopic pyeloplasty between 2012 and 2021. Patient factors evaluated included demographics, history of prematurity (HOP), weight, and American Society of Anesthesiologist classification. Surgical factors included operative time, preop labs, and prior steroid use. Complications were categorized using the Clavien-Dindo (CD) classification.

8221 patients met inclusion criteria. There were 528 (6.4%) readmissions within 30 days. 30 cases, 0.4% were related to obstruction. Urinary Tract Infection (UTI) was the most frequent post-operative complication (n = 232, 2.8%). Median age at the time of surgery was 23 months, 90 patients were <30 days old at the time of surgery. Age <23 months and HOP were associated with CD I-II (OR 1.89, P <.01 and 5.82, P <.05 respectively). Low weight at the time of surgery was associated with CD III-V (OR 0.98, P <.05). HOP was also associated with the incidence of UTI (OR 8.09, P <.05).

Complications after pyeloplasty are rare and most commonly due to UTI. HOP and low weight at the time of surgery were associated with increased complications after pyeloplasty.