Utilization of Augmentation Cystoplasty for Myelomeningocele Patients Remained Stable Over the Past Decade

Abstract Objective To understand the utilization of augmentation cystoplasty (AC) for the management of neurogenic bladder in children with myelomeningocele (MMC). AC carries considerable risk. To mitigate this, recent studies have emphasized alternatives to AC, but it is unknown if these interventions have resulted in fewer ACs being performed. Our goal was to evaluate the use of AC in MMC patients over the past decade. We hypothesized that the use of AC had decreased and that the age at AC increased. Methods Using the Pediatric Health Information System (PHIS), we studied patients with MMC who had an AC between 1/2009 and 12/2018. International Classification of Disease procedure codes were used to identify AC procedures. We quantified trends in AC utilization by estimating the annual proportion of MMC admissions with an AC. We also assessed trends in patient age at the time of AC. Results Proportion of AC per MMC admissions across the study period was 4.8%. There was no significant annual trend in the overall number of ACs performed each quarter over the past decade nor was there any change in the estimated annual incidence rate ratio of AC (1.01, 95% confidence interval (CI) 0.96, 1.05; p=0.75). The estimated annual change in patient age at procedure remained relatively constant over the study period (-0.03 years, 95% CI -0.13, 0.07; p=0.51). Conclusions Practice patterns for the utilization of AC in MMC did not change significantly over the past decade despite prominent voices in the literature emphasizing alternative interventions in this patient population.