Most hypospadias repairs are undertaken on a day case ambulatory basis. Roth et al. have studied clinically significant events occurring within 30 days of operation.

Data was obtained from the Paediatric Health Information System (PHIS), an administrative database that contains patient information from 43 not-for-profit, tertiary care paediatric hospitals in the United States.

The study identified 45,264 hypospadias repairs (2004-2015). Median age at operation was 10.7 months. A total of 4882 (10.8%) of patients had an additional encounter at the same facilities within 30 days. Most encounters (59.1%) were in the Emergency Department (ED) and 1.2% of patients required re-admission. A small number (n=105; 0.2%) required reoperations related to the penis; the most coded procedures were insertion of urinary catheter, dilatation of the urethra, ‘repeat hypospadias repair’ and control of bleeding. Some children had multiple repeat procedures within 30 days. The majority of repeat encounters occurred during the first week after surgery (ED utilisation was greatest during the first 72 hours).

Hypospadias repair is thus safe and low-risk. Study limitations include generation of the cohort from a single ICD-9 code, potentially missing patients if they sought follow-up care at a facility not covered by the PHIS database and that small bedside procedures in ED may not have been captured.

The authors suggest postoperative education could substantially reduce the healthcare burden of these encounters. At our centre, families receive both pre and postoperative teaching from our dedicated specialist nursing team; they are also currently available from Monday-Friday 8am-7pm for postoperative telephone queries or patient review, which I believe minimises workload to our ED and surgical team.

Early readmission and reoperation characteristics of ambulatory hypospadias repair.
Roth JD, Whittam BM, Carroll AE, et al.
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Neil Featherstone

Cambridge University Hospitals NHS Foundation Trust (Addenbrookes Hospital).

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