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Surgical Scar Location Preference for Pediatric Kidney and Pelvic Surgery: A Crowdsourced Survey
Michael L Garcia-Roig1, Curtis Travers1, Courtney McCracken1
1Department of Pediatric Urology, Emory University and Children's Healthcare of Atlanta and Biostatistics Core, Atlanta, Georgia; Department of Pediatrics (CT, CM), Emory University, Atlanta, Georgia.
Insights
Patient preferences for surgical scar location, especially for children, may not prioritize smaller incisions. Discussions should include scar appearance and placement relative to clothing.
Area of Science:
- Urology
- Surgical Oncology
- Pediatric Surgery
Background:
- Minimally invasive surgery (MIS) benefits like reduced hospital stay and pain are less predictable in pediatric urology than in adults.
- Patient preferences for scar location are crucial but understudied, particularly for pediatric procedures.
Purpose of the Study:
- To evaluate adult patients' preferences for scar location and size for themselves and their children undergoing pelvic and kidney surgeries.
- To assess the impact of hidden incisions, hospital stay, and pain on scar location choices.
Main Methods:
- A survey was distributed via Amazon® Mechanical Turk® to 954 adult respondents.
- Participants reported preferences for incision types (e.g., Pfannenstiel, dorsal lumbotomy, flank, laparoscopy) for pelvic and kidney surgeries.
- Respondents reconsidered choices after being informed about potential MIS benefits (reduced pain/hospital stay).
Main Results:
- For pelvic surgery, 75.3% preferred Pfannenstiel incisions when considering undergarment concealment, versus 41.1% initially choosing laparoscopy ports.
- For kidney surgery, 59.4% initially preferred dorsal lumbotomy.
- Incision choices remained consistent after learning about MIS benefits, with higher consistency for laparoscopy in pelvic surgery (71.6%) than Pfannenstiel (53.5%).
- High agreement (82-84.6%) was found between adult choices for themselves and for children.
Conclusions:
- The smallest incision is not always the patient's preferred choice, especially for pediatric surgery where outcomes may be similar across approaches.
- Surgical treatment discussions should incorporate scar characteristics, including length, location, and visibility relative to clothing.
Purpose:
The benefits of minimally invasive surgery in pediatric urology, such as reduced length of hospital stay and postoperative pain, are less predictable compared to findings in the adult literature. We evaluated the choices that adult patients make for themselves and their children regarding scar location.
Materials And Methods:
We surveyed the preference for scar location/size based on surgery for bladder and kidney procedures with additional questions assessing the impact of a hidden incision, length of hospital stay and pain. The survey was posted to Amazon® Mechanical Turk®.
Results:
We analyzed a total of 954 completed surveys. Surgical history was reported in 660 surveys (69%) with scar bother reported in 357 (54.2%). For pelvic surgery the initial choice was a Pfannenstiel incision for 434 respondents (45.5%), laparoscopy port incisions for 392 (41.1%) and no preference for incision location for 126 (13.2%). When incisions were illustrated relative to undergarments, 718 respondents (75.3%) chose Pfannenstiel. For kidney surgery 567 respondents (59.4%) initially chose the dorsal lumbotomy incision, 170 (17.8%) chose a flank incision, 105 (11.0%) chose laparoscopy ports and 110 (11.5%) had no preference. Respondents were told that minimally invasive surgery might result in less pain/length of hospital stay and were asked to restate the incision choice. For pelvic surgery 232 of 434 respondents (53.5%) who had chosen Pfannenstiel and 282 of 394 (71.6%) who had chosen laparoscopy remained consistent (p <0.001). For kidney surgery 96 respondents (56.5%) who chose a flank incision, 322 (56.8%) who chose dorsal lumbotomy and 68 (64.2%) who chose laparoscopy remained consistent (p = 0.349). Agreement between the incision choice by respondent as a child and for a child was 82% (κ = 0.69) for pelvic surgery and 84.6% (κ = 0.75) for kidney surgery.
Conclusions:
The smallest incision is not always the patient preferred incision, particularly in childhood when pain, length of hospital stay and blood loss may be equivocal among approaches. Discussion of surgical treatment options should include scar length, location and relationship to undergarments.
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