Unplanned emergency department presentations in the first 30 days post hypospadias repair – the patient and familial experience of care

Abstract

There is limited literature regarding patient and family experiences in the post-operative period following hypospadias repair. We reviewed unplanned emergency department (ED) presentations following hypospadias repair at our centre to better understand this issue. A prospectively maintained database of consecutive patients undergoing primary hypospadias repairs for distal (n=188), midshaft (n=25) and proximal (n=45) hypospadias under the supervision of 8 different paediatric surgeons at our centre was queried for ED presentations within 30 days of operation. Indications, time to presentation and number of presentations were assessed. Planned follow-ups were excluded. Risk factors analysed were age, American Society of Anaesthesiologist’s (ASA) grade, hypospadias type, regional anaesthesia, Index of Relative Socioeconomic Disadvantage (IRSD) decile and Accessibility/Remoteness Index of Australia (ARIA) score. Univariate and Multivariate analysis was performed using logistic regression. Between January 2015 to December 2018, 258 consecutive patients had primary hypospadias repairs at our centre. Unplanned ED presentations occurred in 63/258 (26.6%) of patients. Most patients presented between Day 0 and Day 3 (50/63, 79%) and presented only once (41/63, 65.1%). The most common primary reason for re-presentation was soiled dressings (31/63, 49.2%). Four patients (6.3%) required a return to theatre for catheter displacement (n=3) and urinary retention secondary to a blocked catheter (n=1). No risk factor assessed was significant on univariate regression for re-presentation within 30 days. Unplanned ED presentations post hypospadias repair are common in our centre. In the majority of cases, education or reassurance was the only intervention required. No surgical or patient factor was prognostic for re-presentation. It is important to communicate clearly to family’s expectations for the post-operative period. Further prospective investigations into the patient and familial experiences post hypospadias repair are required.