US News & World Report (USNWR) provide rankings on a wide range of topics (education, health, money, travel, cars and law firms). In terms of healthcare, they suggest that their rankings (based on metrics) are a tool that can help patients find sources of especially skilled inpatient care. Obviously, those ranked more highly may attract more business; 50 paediatric centres have been ranked overall for their care of serious urological conditions. In terms of hypospadias surgery, paediatric urology centres receive 0, 1, 2, or 3 points for quality if their complication rates are >5%, 3-5%, 1-3% and less than 1% respectively for distal hypospadias repairs and >15%, 10-15%, 5-10% and less than 5% respectively for proximal repairs. Pohl et al. have interrogated the Pediatric health Information System (PHIS) which contains demographics, outcomes and resource utilisation data. Group A included codes sought by USNWR, Group B included group A plus codes for acquired fistulae and Group C included group B and revision codes associated with the index procedure. They report that 19,931 boys underwent distal hypospadias procedures and 5840 boys had proximal hypospadias repairs (January 2010 to December 2016). Average complication rates for Group A were 3.32% and 12.29% respectively for distal vs. proximal repairs. When revision coding was utilised for distal repairs, complication rates increased: 4.26% (Group B) and 6.37% (Group C). In proximal repairs, there was no significant increase in complication rates in Group B (12.53%) but there was a significant increase in Group C (22.14%). The authors rightly point out that the USNWR expected outcomes do not correlate with the reported rates of complications for hypospadias surgeries. Surgical outcomes can only be assessed with sufficiently long follow-up. Historical data may suggest complication rates 5-10% in distal repairs and 12-23% in proximal repairs; however, recent reports show that revisions may be required in up to around 50% of cases. In this study, no hospitals met the USNWR definition of perfection and are these measures not therefore somewhat illogical and flawed?
Hypospadias – can urologists achieve the unachievable?
Reviewed by Neil Featherstone
Discrepant rates of hypospadias surgical complications: a comparison of U.S. News & World Report and Pediatric Health Information System Data® and published literature.
CONTRIBUTOR
Neil Featherstone
Cambridge University Hospitals NHS Foundation Trust (Addenbrookes Hospital).
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