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Nieuwhof-Leppink AJ, Garriboli M, Cascio S, Braga LH, Haid B, Nelson CP, Dönmez MI, Ching CB, Harper L. Elevating pediatric urology care: The crucial role of nursing research in quality improvement. J Pediatr Urol 2024; 20:522-525. [PMID: 38360426 DOI: 10.1016/j.jpurol.2024.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/17/2024]
Abstract
This educational article highlights the critical role of pediatric urology nursing research in improving the care of children with urological conditions. It discusses the multifaceted nature of pediatric urology nursing, addresses challenges such as limited nurse scientists and resource constraints, and highlights the need to overcome barriers to increase research involvement. The authors emphasize the importance of prioritizing research areas, the promotion of collaboration, and the provision of adequate funding and academic time for pediatric nurses to contribute to evidence-based practice, to improve patient outcomes. Furthermore, it highlights the importance of research in advancing nursing practice, shaping protocols, and advocating for the rights and needs of children with urological conditions and their families.
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Affiliation(s)
- Anka J Nieuwhof-Leppink
- Department Urotherapy, Medical Psychology and Urology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, Netherlands.
| | - Massimo Garriboli
- Department of Pediatric Urology, Evelina London Children's Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom.
| | - Salvatore Cascio
- Department of Pediatric Surgery, School of Medicine, University College Dublin and Children's Health Ireland, Dublin, Ireland.
| | - Luis H Braga
- Department of Surgery, Division of Urology, McMaster University, McMaster Children's Hospital, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada.
| | - Bernhard Haid
- Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Austria.
| | - Caleb P Nelson
- Department of Urology, Boston Children's Hospital and Harvard Medical School, USA.
| | - Muhammet Irfan Dönmez
- Division of Pediatric Urology, Department of Urology, Istanbul University Istanbul Faculty of Medicine, Turkey.
| | - Christina B Ching
- Department of Pediatric Urology, Nationwide Children's Hospital, 700 Children's Dr Columbus, OH 43205, USA.
| | - Luke Harper
- Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France.
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Johnson EK, Hyman MJ, Hardy C, Maizels M, Seager CM, Matoka DJ, Liu DB, Gong EM, Holl JL, Modi PK. Growth in Newborn Circumcisions Performed by Pediatric Urologists and Advanced Practice Providers Between 2010 and 2021 in the United States. Urology 2024; 184:206-211. [PMID: 37979701 DOI: 10.1016/j.urology.2023.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/23/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVE To characterize changes in the proportion of newborn circumcisions performed by pediatric urologists and advanced practiced providers (APPs) in the United States over the last decade. METHODS The Merative MarketScan Commercial Database was queried for newborn circumcision private health insurance claims (Common Procedural Terminology 54150) between 2010 and 2021. Setting (inpatient/outpatient), US Census Bureau region, clinician specialty, and patient age (days) were determined for the full study time period, and by study year. Simple linear regression assessed growth in proportion of newborn circumcisions performed by pediatric urologists and APPs (nurse practitioner/physician assistant/midwife), over time. RESULTS In total, 1,006,748 newborn circumcisions (59% inpatient) were identified; while most were performed by obstetricians (45%) or pediatricians (33%); APPs performed 0.9%, and pediatric urologists performed 0.7%. From 2010-2021, the proportion of newborn circumcisions performed by pediatric urologists increased from 0.3% to 2.0% and by APPs in from 0.5% to 2.9% (P < .001 for both). Growth for both pediatric urologists and APPs occurred APPs predominantly from 2016 to 2021. Trends in proportion of newborn circumcision performed by pediatricians was stable [31.5% (2010) and 32.5% (2021)], but decreased for obstetricians [48.8% (2014) and 38.1% (2021)]. CONCLUSION The proportion of newborn circumcisions performed by pediatric urologists and APPs increased more than 6-fold between 2010 and 2021, though both specialties still perform a minority of newborn circumcisions. These data provide important baseline information for newborn circumcision workforce planning, including evaluating collaborative care models where pediatric urologists train APPs to perform circumcision.
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Affiliation(s)
- Emilie K Johnson
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Max J Hyman
- The Center for Health and the Social Sciences, The University of Chicago, Chicago, IL
| | - Camille Hardy
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Max Maizels
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Catherine M Seager
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Derek J Matoka
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Dennis B Liu
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Edward M Gong
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jane L Holl
- Department of Neurology, Center for Healthcare Delivery Science and Innovation, University of Chicago, Chicago, IL
| | - Parth K Modi
- Section of Urology, Department of Surgery, The University of Chicago, Chicago, IL
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Johnson EK, Rosoklija I, Walton RF, Matoka DJ, Seager CM, Holl JL. Physician Perspectives on Performing Newborn Circumcisions: Barriers and Opportunities. Matern Child Health J 2024; 28:144-154. [PMID: 37919635 DOI: 10.1007/s10995-023-03822-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE Over half of infant boys born in the United States undergo newborn circumcision. However, available data indicate that boys who are publicly insured, or Black/African American, have less access to desired newborn circumcision, thus concentrating riskier, more costly operative circumcision among these populations. This study ascertains perinatal physician perspectives about barriers and facilitators to providing newborn circumcisions, with a goal of informing future strategies to ensure more equitable access. METHODS Qualitative interviews about newborn circumcision care were conducted from April-June 2020 at eleven Chicago-Area hospitals. Physicians that provide perinatal care (pediatricians, family medicine physicians, and obstetricians) participated in qualitative interviews about newborn circumcision. Inductive and deductive qualitative coding was performed to identify themes related to barriers and facilitators of newborn circumcision care. RESULTS The 23 participating physicians (78% female, 74% white, median 16 years since medical school graduation [range 5-38 years], 52% hospital leadership role, 78% currently perform circumcisions) reported multiple barriers including difficulty with procedural logistics and inconsistent clinician availability and training; corresponding suggestions for operational improvements were also provided. Regarding newborn circumcision insurance coverage and reimbursement, physicians reported limited knowledge, but noted that some insurance reimbursement policies financially disincentivize clinicians and hospitals from offering inpatient newborn circumcision. CONCLUSIONS Physicians identified logistical/operational, and reimbursement-related barriers to providing newborn circumcision for desirous families. Future studies and advocacy work should focus on developing clinical strategies and healthcare policies to ensure equitable access, and incentivize clinicians/hospitals to perform newborn circumcisions.
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Affiliation(s)
- Emilie K Johnson
- Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave Box 24, Chicago, IL, 60611, USA.
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Ilina Rosoklija
- Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave Box 24, Chicago, IL, 60611, USA
| | - Ryan F Walton
- Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave Box 24, Chicago, IL, 60611, USA
| | - Derek J Matoka
- Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave Box 24, Chicago, IL, 60611, USA
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Catherine M Seager
- Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave Box 24, Chicago, IL, 60611, USA
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jane L Holl
- Division of Biological Sciences, University of Chicago, Chicago, IL, USA
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Williams VW, Finkelstein JB. Speaking and listening: The importance of stakeholder engagement in quality improvement in pediatric urology. J Pediatr Urol 2023; 19:792-799. [PMID: 37689553 DOI: 10.1016/j.jpurol.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/04/2023] [Accepted: 08/17/2023] [Indexed: 09/11/2023]
Abstract
To improve health care, we as clinicians must work to change processes that make it easier to do our job well and reliably every day. Before improving a process, we must understand it and this often requires employing the expertise of others. Indeed, quality improvement work is often done in teams. The key is identifying and engaging the right stakeholders for each improvement initiative. The goal of this review is to provide health care professionals with the basis for how to do this. We describe four essential stakeholder steps that aid in the success of a quality improvement initiative. The steps of 1.) identifying and 2.) categorizing stakeholders involve spending the time to think about who the necessary stakeholders are and how to organize them. It is essential to consider stakeholders who are balanced for expertise, skills, experience, perspective, gender, race, and ethnicity. The process then moves on to 3.) analyzing stakeholders, which supports efforts that are focused on the stakeholder relationships that will most impact project success. The final step is 4.) stakeholder engagement. This represents a critical opportunity, not only upfront, but also to maintain a high level of stakeholder engagement throughout the quality improvement project. As the improvement work evolves, it is important to return to the earlier steps and reflect on the stakeholder group; the process is iterative. Devoting sufficient energy and time to these stakeholder steps will provide ample returns. This review should assist health care professionals in establishing an improvement team for each quality improvement initiative, which is foundational to initiating change efforts that better system performance, enhance the quality of care, and ensure patient safety.
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Grota T, Betihavas V, Burston A, Jacob E. Roles of nurse-surgeons in global surgical care: A scoping review. J Adv Nurs 2023. [PMID: 37897097 DOI: 10.1111/jan.15906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/27/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023]
Abstract
AIM To identify the roles of nurse-surgeons in the provision of surgical care. DESIGN Scoping review. METHODS This scoping review adhered to the JBI guideline for scoping reviews and EQUATOR Network's PRISMA-ScR checklist. Searches were performed from May 2022 to July 2022 using a combination of MeSH headings, keywords and filters via database and hand searching based on the eligibility criteria. Keywords included nurse-surgeon, nurse endoscopist, nurse hysteroscopist and nurse cystoscopist. Data sources were CINAHL, Cochrane, Google Scholar, PubMed and Scopus. Descriptive analysis was used to report the findings. RESULTS Ninety-six included records indicated nurse-surgeon practice in 26 countries. Forty-one nurse-surgeon titles were found, the majority of which were types of nurse practitioner. A total of 5,684,198 surgeries were performed by nurse-surgeons varying from laparotomies to biopsies. Nine records reported that nurse-surgeons perform surgeries safely and on par with physicians with zero to minimal complications. Nineteen records reported improved surgical care efficiency by nurse-surgeons in terms of patient access to surgery, waiting times, surgery times, patient show rates, patient education, physician workload and junior physicians' training. Seven records reported high patient satisfaction. Nurse-surgeons were cost-effective according to five records. Thirteen records recommended the standardization of nurse-surgeon practice. CONCLUSION Nurse-surgeons performed millions of surgeries worldwide assisting in easing the global surgical burden. This review identified the roles and benefits nurse-surgeons play in global surgical care. Research gaps on nurse-surgeon roles were discovered including the ambiguity in nurse-surgeon titles and the need to regulate nurse-surgeon practice. IMPACT This research addressed the clinical safety, quality, contribution to timely surgical access and cost efficiency of nurse-surgeon performed surgeries, as well as the need to standardize nurse-surgeon practice and use a more consistent nurse-surgeon title to ensure role identification and monitoring.
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Affiliation(s)
- Tenber Grota
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, New South Wales, Australia
| | - Vasiliki Betihavas
- School of Nursing & Midwifery, University of Notre Dame, Darlinghurst, New South Wales, Australia
| | - Adam Burston
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, New South Wales, Australia
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Elisabeth Jacob
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, New South Wales, Australia
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Kamanzi SN, Walton RF, Rosoklija I, Corona LE, Holl JL, Johnson EK. Differential Insurance Plan Coverage and Surgeon Reimbursement of Pediatric Circumcision at an Urban, Midwestern Hospital. Urology 2023; 179:143-150. [PMID: 37343682 DOI: 10.1016/j.urology.2023.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/01/2023] [Accepted: 04/10/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE To explore private vs public pediatric circumcision insurance coverage and surgeon reimbursement. METHODS A telephone survey about circumcision coverage (Current Procedural Terminology codes: 54150, 54161) was conducted in October 2021 with insurance plan representatives from the 12 plans that comprised ≥1% of institutional pediatric urology visits to compare plan characteristics and coverage details. Circumcision billing data were collected at one pediatric hospital to assess surgeon reimbursement (insurance+patient payment) by plan type using bivariate statistics. RESULTS Ten plans (5 private and 5 public) responded (83.3% response rate). All except one public plan covered newborn circumcision. For non-newborn circumcisions, most public plans (80%) had unrestricted coverage, whereas all private plans required medical necessity. Median reimbursement for newborn circumcision (CPT: 54150) was $484 for private and $78 for public plans, P < .001 while median reimbursement for non-newborn circumcision (CPT: 54161) was $314 for private and $147 for public plans, P < .001. CONCLUSION Private insurance plans reimburse significantly more than public plans for newborn circumcision. For non-newborn circumcision, private plans reimburse more than public but the coverage is more restricted, with a smaller differential between newborn and non-newborn circumcision. This coverage and reimbursement structure may indirectly encourage newborn circumcision for privately insured boys and non-newborn circumcision for publicly insured boys.
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Affiliation(s)
- Sophia N Kamanzi
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Ryan F Walton
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Ilina Rosoklija
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Lauren E Corona
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Jane L Holl
- Department of Neurology, Center for Healthcare Delivery Science and Innovation, University of Chicago, Chicago, IL
| | - Emilie K Johnson
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
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Grota T, Betihavas V, Burston A, Jacob E. Impact of nurse-surgeons on patient-centred outcomes: A systematic review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100086. [PMID: 38745634 PMCID: PMC11080547 DOI: 10.1016/j.ijnsa.2022.100086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 06/17/2022] [Accepted: 06/29/2022] [Indexed: 11/21/2022] Open
Abstract
Background Nurse-surgeons have been performing surgeries for decades. Yet, their impact on perioperative clinical outcomes has not been explored in detail. Objective To investigate the impact of nurse-surgeons on patient-centred outcomes. Design Systematic review. Method The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram and checklist for systematic reviews were used as the screening and reporting guideline. CINAHL, Cochrane Library, MEDLINE, and PubMed databases were searched for articles that fit the review's eligibility criteria. A combination of Medical Subject Headings, keywords and filters for each database were used. Following screening and full text review, the Mixed Methods Appraisal Tool was used for quality assessment and the Grading of Recommendations, Assessment, Development and Evaluations framework for certainty and confidence assessment. Narrative synthesis was used to report the findings due to the design heterogeneity of the included studies. Results Forty-eight (n = 48) patient-centred outcomes were identified from 25 included studies. These outcomes were grouped into four categories: patient satisfaction and experience; waiting list; perioperative complications; and quality of surgical care. Patient satisfaction and experience was rated high to very high in 16 studies; none reported patient dissatisfaction. Waiting lists improved in eight studies. Perioperative complications were none to very low in nine studies. Mortality rates in the nurse-surgeon group were better than the physician group in three studies. The quality of care in the performance of surgeries by nurse-surgeons was either similar or better than physicians in ten studies. Conclusions Nurse-surgeons performed safe, satisfactory, and high-quality surgeries with minimal perioperative complications similar to physicians. The use of nurse-surgeons has significantly reduced waiting lists regardless of surgical speciality. Policies around nurse-surgeon practice needs to be developed at national and international levels to streamline the delivery of much needed surgical services amidst the coronavirus pandemic in the areas of cancer diagnostic surgeries, emergency surgeries, minor surgeries, and remote and rural health.
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Affiliation(s)
- Tenber Grota
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, NSW 2060, Australia
| | - Vasiliki Betihavas
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, NSW 2060, Australia
| | - Adam Burston
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, QLD 4032, Australia
| | - Elisabeth Jacob
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, NSW 2060, Australia
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Parent Satisfaction With Pediatric Nurse Practitioner Care in Specialty Services. J Pediatr Health Care 2022; 36:457-464. [PMID: 35568623 DOI: 10.1016/j.pedhc.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/31/2022] [Accepted: 04/02/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION This study examined parent satisfaction with care provided to their children by Pediatric Nurse Practitioners (PNPs) in specialty areas at a tertiary care pediatric hospital. METHOD A convenience sample of parents of children cared for by 19 PNPs in different specialty settings completed a confidential survey consisting of demographic information and the Parents' Perception of Satisfaction with Care from the Pediatric Nurse Practitioners Instrument (PPSC-PNP). Data were analyzed using SPSS (IBM, Armonk, NY). RESULTS The overall PPSC-PNP mean score was 129.82/140. Mean subscale scores ranged from 27.15 to 28.51/30. The general satisfaction score showed a mean score of 18.31/20. No statistical difference was found in parental satisfaction when scores were analyzed by the child's age, parent participant, or patient setting. DISCUSSION These findings indicate that parents are highly satisfied with the care their children receive from PNPs across various subspecialties regardless of the child's age and clinical setting.
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Skertich NJ, Sullivan GA, Herberg RE, Gulack BC, Beth Madonna M, Pillai S, Shah AN. The effect of inpatient versus outpatient location on postoperative healthcare utilization after neonatal circumcision. J Pediatr Surg 2022; 57:1072-1075. [PMID: 35277248 DOI: 10.1016/j.jpedsurg.2022.01.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/31/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND/PURPOSE Neonatal circumcision is a common pediatric procedure performed in both the inpatient and outpatient setting. We aimed to determine if procedure location affected 30-day post-procedure healthcare utilization rates, inpatient length of stay (LOS), and amount charged. METHODS We performed a retrospective cohort study comparing 30-day postoperative healthcare utilization (emergency department (ED) visits, office visits, readmissions) of full-term infants who underwent an outpatient versus inpatient (same admission as birth) circumcision from 2015 to 2020. Statistical analyses included Chi-square tests, multivariable adjusted logistic regression models when appropriate. RESULTS 3137 infants were included, 1426 (45.5%) had an outpatient circumcision, 1711 (54.5%) an inpatient. Outpatient had similar overall healthcare utilization rates as inpatients (5.7% vs. 5.6%, p = 0.933). The number of ED visits (1.5% vs 0.8%, p = 0.055), office visits (4.5% vs. 5.1%, p = 0.437), and readmissions (0.2% vs. 0.0%, p = 0.058) were not significantly different. Infants with inpatient circumcisions had longer LOS after adjusting for age, ethnicity and delivery type (Cesarean versus vaginal) with an incident rate ratio of 1.97 (95% confidence interval 1.84-2.11, p<0.001). Outpatient circumcision resulted in average charges of $372 more than inpatient. CONCLUSIONS Outpatient circumcision has a minimal effect on healthcare utilization rates but lead to a shorter hospital stay following birth and increased charge. STUDY DESIGN Retrospective LEVEL OF EVIDENCE: III.
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Affiliation(s)
- Nicholas J Skertich
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL 60612, United States.
| | - Gwyneth A Sullivan
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL 60612, United States
| | | | - Brian C Gulack
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL 60612, United States
| | - Mary Beth Madonna
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL 60612, United States
| | - Srikumar Pillai
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL 60612, United States
| | - Ami N Shah
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL 60612, United States
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