C. N. Litz1, M. McGuire1, P. D. Danielson1, N. M. Chandler1 1Johns Hopkins All Children’s Hospital,Division Of Pediatric Surgery,St. Petersburg, FL, USA
Introduction: Postoperative clinic visits are routine practice in the field of surgery; however, their value is unclear after low-risk operations. The purpose of this study was to determine patient preferences regarding clinic visits after routine operations and evaluate the utility of these visits by determining if any interventions were performed.
Methods: Patients aged 18-21 years of age or the parents/legal guardians of patients aged 0-17 years of age who underwent appendectomy, pyloromyotomy, umbilical hernia repair, inguinal hernia repair, circumcision, or supernumerary digit removal between 11/18/15-8/1/16 were approached at the postoperative visit to complete a survey. The survey was created and analyzed using a web-based survey platform. The variables included demographic information, work and/or school missed, travel time, internet access and frequency of use, visit information, and perceived comfort with and usefulness of alternative means of follow-up. In addition, medical records were reviewed to determine if interventions were performed during the clinic visit.
Results: There were 329 operations performed (66% non-elective and 34% elective) and 235 patients (71%) followed up in clinic during the study period. The survey was completed by 131 patients or guardians. Demographic data is shown in Table 1. Overall, 70% preferred an in-person clinic visit over follow-up via a phone call, email or internet portal and this did not significantly differ by parental age, education level, elective or non-elective operation, time traveled, work and/or school missed, or frequency of email use. Patients with concerns that were addressed were more likely to prefer clinic follow-up (81%) compared to those with concerns that were not addressed (44%) or those without concerns (43%) (p<0.01). Patients evaluated by surgeons were more likely to prefer follow-up in clinic (74%) compared to those evaluated by advanced practice providers (58%); however, the difference was not statistically significant (p=0.09). The most common reasons respondents preferred follow-up via electronic communication were missed work (57%), long travel (48%), and missed school (33%). Additional measures performed as a result of the visit, including prescribing medication, performing an intervention, ordering laboratory or radiologic studies, and scheduling an additional clinic appointment, were performed in six patients (5%).
Conclusion: Postoperative clinic visits after routine operations in pediatric patients have low utility. However, despite the significant time required to travel to the clinic and decreased productivity from missing work and/or school, the majority of our patients prefer in-person follow-up in clinic.
