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Incidence of Repeat Dextranomer/Hyaluronic Acid Copolymer Injection Among Pediatric Health Information System Hospitals
Katherine Herbst1, John H. Makari2, Christina Kim2, Fernando Ferrer2, Anthony Caldamone3
1Connecticut Children's Medical Center, Hartford, CT;2Connecticut Children's Medical Center/University of Connecticut Health Center, Hartford/Farmington, CT;3Hasbro Children's Hospital/Brown University School of Medicine, Providence, RI

Introduction:Success rates after single dextranomer/hyaluronic acid (DxHA) injection for vesicoureteral reflux (VUR) are variable. Those failing initial injection are candidates for a 2nd injection. The purpose of this study is to analyze trends in the utilization of repeat DxHA injection among patients treated at hospitals participating in the Pediatric Health Information System Database (PHIS).
Materials & Methods:Billing records for patients who underwent DxHA injection for primary VUR between 1/1/2007 and 9/30/2009 were extracted from the PHIS database. Patient history was reviewed and patients with previous DxHA or ureteral reimplantation were excluded. Patient records with 1 to 3 years follow-up were analyzed to identify additional DxHA injection or reimplantation procedures.
Results:24/43 hospitals submitted CPT Code level data during the study period. 2,817 patients who received initial injection were identified. 85% of patients were female. Median age at first injection was 5 years (+/- 3.7 yrs). 89% of patients received unilateral injection, 11% bilateral injection. 9% (254) had an additional procedure (9% of unilateral patients, 11% of bilateral patients). 190 (7%) of unilateral patients received a 2nd injection, 9 (0.4%) received a 3rd. Among bilateral patients, 8% received a 2nd unilateral injection, 1% received 2nd bilateral injections. 22 (0.8%) patients had subsequent reimplantation (20 unilateral, 2 bilateral).
Conclusions:
Within the limits of the database, these Results suggest that, in patients who have undergone DxHA injection, the rate of repeat DxHA injection is low and open reimplantation is much lower, indicating a trend for continued endoscopic management in this population with VUR.


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