Outpatient pediatric urological surgery: techniques for a successful and cost-effective practice

Of 674 operations performed in the pediatric urology division between January and October 1984, 62 per cent were done on an outpatient and 12 per cent on a 1-night stay basis. The outpatient procedures included major proximal hypospadias repairs and intra-abdominal procedures, as well as inguinal, penile, scrotal and endoscopic procedures. No child required subsequent hospitalization. This successful approach was contingent upon proper patient selection, patient and family education, modern anesthetic and monitoring techniques, and careful followup. For elective procedures, such as hypospadias repairs, patients are operated on when they are 6 to 18 months old. Modern anesthetic techniques include isoflurane to maintain a light level of general anesthesia and adjunctive regional blocking procedures. The availability of a physician support service on a 24-hour basis is fundamental to the success of this approach. Benefits include patient, parental and physician satisfaction, diminished potential for nosocomial disease transmission and avoidance of the emotional stress of parent-child separation. Increased use of outpatient surgery is a means to produce a significant decrease in the cost of medical care.