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Reoperation Risk in Distal Hypospadias: A Multicenter Study Utilizing the Live TriNetX Claims Database
Angelina Kuzina, B.S.1, Richard Grunert, M.D.
1, Mohammad Mohaghegh, M.D.
1, Gerald Mingin, M.D.
1, Sarah Kohl, B.S.
1, Benjamin Rubin, B.S.
1, Jacob Bleau, B.S.
1, Nicholas Khoo, B.S.
1, Daehee Jeong, B.A.
2.
1The Robert Larner, M.D. College of Medicine at The University of Vermont, Burlington, VT, USA,
2Washington University School of Medicine, St. Louis, MO, USA.
Background Distal hypospadias, encompassing balanic and penile subtypes, is typically repaired between 6 and 18 months of age. Reported reoperation rates vary widely (5%-70%) due to differences in surgical technique, follow-up protocols, and patient factors. This study uses a real-time, multicenter claims database to generate updated reoperation rates and assess subtype-specific differences.
Methods An observational study was conducted using the TriNetX Dataset Network, a live global claims database. Pediatric patients (≤18 years) diagnosed with balanic or penile hypospadias were identified using ICD-10 codes. One-stage primary repairs and subsequent reoperations for complications were identified using CPT codes. Patients with perineal or penoscrotal hypospadias, or multi-stage repairs, were excluded. A chi-square test was used to compare reoperation rates; Cramer’s V assessed association strength.
Results A total of 4,918 patients were identified; 2,230 with balanic and 2,688 with penile hypospadias. Reoperations occurred in 45 balanic (2.02%) and 188 penile (6.99%) cases. The mean age at initial surgery was 9.6 ± 22.5 months for balanic and 7.3 ± 16.9 months for penile cases. Time to reoperation averaged 605.3 ± 506.8 days for balanic and 566.7 ± 549.7 days for penile. Reoperation rates differed significantly (χ² = 65.77, p < 0.001), though Cramer’s V indicated a weak association (0.116).
Conclusion Penile hypospadias repairs had higher reoperation rates than balanic, but subtype alone was a weak predictor of outcome. These findings support the utility of real-time claims databases in evaluating surgical outcomes at scale and may help guide future individualized treatment approaches.
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