Division of Urology, Department of Surgery, University of Colorado Anschutz Medical Campus, 12631 East 17th Ave., M/S C-319, Aurora, CO, 80045, USA.
Department of Urology, Children's Hospital Colorado, 13123 E 16th Ave., Box 463, Aurora, CO, 80045, USA.
J Pediatr Urol. 2019 May;15(3):227.e1-227.e6. doi: 10.1016/j.jpurol.2019.02.016. Epub 2019 Mar 7.
Surgery in children is increasingly ambulatory, and caregiver responsibilities for postoperative care can produce anxiety. Prior studies have suggested the distribution of a photographic atlas can mitigate caregiver anxiety and reduce clinic phone calls and in-person presentations after pediatric penile surgery.
A pilot study of the ability of a photographic atlas, distributed to caregivers, was aimed to be conducted to reduce postoperative resource utilization.
Patients undergoing circumcision or revision circumcision were randomized to standard postoperative instructions vs. standard instructions with a photographic atlas representing appropriate penile appearance at successive time points. Electronic records were reviewed for phone calls or in-person presentations to the clinic or emergency department (ED) within 1 month of surgery.
Fourteen patients (44%) received the atlas, and 18 (56%) did not. Patients who received the atlas did not differ significantly from patients who did not receive it in their rate of clinic phone calls (36% vs 39%, p = 0.85), calls per patient (0.5 vs. 0.7, p = 0.78), ED visits (7% vs. 11%, p = 0.70), calls and visits combined (44% vs. 43%, p = 0.93), or the proportion of calls and emergency room presentations related to concerns about the penile appearance (22% vs. 36%, p = 0.66). Overall, 19 postoperative phone calls were received from 12 patients, and 4 visits to the ED were made by 3 patients. Reasons for calls to the clinic were diverse, and 9 distinct categories of concern were identified apart from wound appearance.
The impressive diversity of caregiver concerns prompting postoperative communication may partly underlie the failure of the atlas to reduce resource utilization in this study. Most postoperative calls or visits were unrelated to concern about the penile appearance, which limits the degree to which this or any visual guide to wound healing can reduce the need for postoperative attention.
Receipt of the atlas did not significantly reduce postoperative contacts or affect the proportion of contacts represented by concerns about penile appearance. Resources must remain directed toward individualized attention to caregiver concerns, delivered by experienced urologic support staffs, who remain the mainstay of postoperative support.
儿童手术越来越多地采用门诊手术，而照顾者对术后护理的责任可能会产生焦虑。先前的研究表明，分发摄影图谱可以减轻照顾者的焦虑，并减少儿童阴茎手术后的诊所电话咨询和就诊次数。
本研究旨在通过对接受包皮环切术或包皮环切术修正术的患儿进行一项摄影图谱的初步研究，以减少术后资源的利用。
将患者随机分为接受标准术后指导的患者和接受标准指导加代表术后不同时间点阴茎适当外观的摄影图谱的患者。对术后 1 个月内到诊所或急诊部（ED）的电话咨询或就诊的电子记录进行回顾。
14 名患者（44%）接受了图谱，18 名患者（56%）未接受图谱。接受图谱的患者与未接受图谱的患者在诊所电话咨询率（36% vs. 39%，p=0.85）、每位患者的电话咨询次数（0.5 次 vs. 0.7 次，p=0.78）、ED 就诊率（7% vs. 11%，p=0.70）、电话咨询和就诊次数（44% vs. 43%，p=0.93）或与阴茎外观相关的电话咨询和 ED 就诊比例（22% vs. 36%，p=0.66）方面均无显著差异。总体而言，12 名患者共进行了 19 次术后电话咨询，3 名患者到 ED 就诊 4 次。就诊的原因多种多样，除了伤口外观，还确定了 9 种不同的关注类别。
促使术后沟通的照顾者担忧的显著多样性可能部分解释了图谱在本研究中未能减少资源利用的原因。大多数术后电话咨询或就诊都与阴茎外观无关，这限制了图谱或任何伤口愈合视觉指南在减少术后关注方面的作用程度。
接受图谱并没有显著减少术后联系，也没有影响与阴茎外观相关的联系比例。资源必须继续致力于满足照顾者的个性化需求，由经验丰富的泌尿科支持人员提供，这些人员仍然是术后支持的主要力量。
