E. M. Knott1, S. Suh2, B. A. Dalton1, T. A. Wattsman2, S. D. St. Peter1, S. R. Shah1 1Chidren’s Mercy Hospital,Pediatric Surgery,Kansas City, MO, USA 2Virginia Tech Carilion School Of Medicine,Pediatric Surgery,Roanoke, VA, USA
Introduction:
The rate of postoperative complication is extremely low for common pediatric surgical procedures such as hernia repair, circumcision and pyloromyotomy. However, most surgeons continue to request patients return for routine follow-up after these procedures. The objective of this study was to evaluate the necessity of routine follow-up by determining the rate of interventions performed during the postoperative period at scheduled clinic follow-ups and emergency department visits.
Methods:
A retrospective review was performed of all patients undergoing inguinal hernia repair, umbilical hernia repair, epigastric hernia repair, circumcision, or laparoscopic pyloromyotomy at two institutions during a 6 month period. Charts were reviewed for postoperative clinic and emergency department visits during the initial 90 days after surgery. An intervention was defined as any laboratory or radiographic workup, prescription of medications, hospital admission, or scheduling further follow-up visits.
Results:
Chart review was performed in 270 patients undergoing the following procedures (n): inguinal hernia repair (76), umbilical hernia repair (42), epigastric hernia repair (9), circumcision (126), laparoscopic pyloromyotomy (10), or some combination of the above (7). Of these, 146 patients (54.1%) were seen in the surgery clinic for follow-up at a mean of 23.7 ± 12.7 days after the procedure. Thirteen of these follow-ups required an intervention: 12 after circumcision (related to wound healing or adhesions) and 1 after laparoscopic pyloromyotomy (for an umbilical granuloma). Fourteen patients (5.2%) visited the emergency department during the postoperative period at a mean of 8.3 ± 7.1 days (range 2-21 days) after the procedure. Of these, 8 required an intervention: 2 after inguinal hernia repair (pain and cellulitis), 1 after epigastric hernia repair (cellulitis), 3 after circumcision (pain, cellulitis or bleeding), and 2 after pyloromyotomy (irritability and emesis). No patients required readmission, and one patient required reoperation (for lysis of penile adhesions) during the follow- up period.
Conclusion:
These data demonstrate that patients after inguinal hernia repair, umbilical hernia repair, epigastric hernia repair, circumcision, and laparoscopic pyloromyotomy have a low rate of follow-up. Of those that are seen in the postoperative period very few require any intervention, and patients having undergone circumcision are the ones that most frequently prompt an intervention. Based on these data routine postoperative follow-up for select common pediatric surgical procedures may not be necessary and alternatives should be further investigated.