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Outcome assessment of office Plastibell circumcision in infants utilizing interactive electronic health record
Modupeola Diyaolu1, Taylor Perry2, Nicole Hui2
1Department of Surgery, Division of General Surgery, Stanford University School of Medicine, Stanford, CA, USA.
Insights
Utilizing interactive electronic health records (iEHR) for infant circumcision care improved complication detection and management. This system facilitated early intervention for issues like ring retention and proximal migration, enhancing patient outcomes.
Area of Science:
- Pediatric surgery
- Urology
- Digital health
Background:
- Office-based infant circumcision is common.
- Effective post-procedure monitoring is crucial for identifying complications.
- Traditional follow-up methods may have limitations.
Purpose of the Study:
- To evaluate the effectiveness of the MyChart interactive electronic health record (iEHR) system for monitoring infant circumcision outcomes.
- To assess complication rates and management using iEHR in Plastibell circumcisions.
- To determine if iEHR facilitates early detection and intervention of post-circumcision issues.
Main Methods:
- Prospective cohort study of 234 infants undergoing Plastibell circumcision (March 2021-April 2022).
- Parents used MyChart to report concerns and submit photos of the circumcision site.
- Telehealth or in-person visits were arranged based on iEHR communication.
- Complications were documented and compared to literature.
Main Results:
- 170 parents (73%) actively used MyChart.
- 14 (6%) complications required intervention, including ring retention (11) and proximal ring migration (6).
- iEHR facilitated early intervention for 14 infants and prevented unnecessary visits for 17 others.
- Switching from cotton to silk ties reduced incomplete skin division complications.
Conclusions:
- Interactive iEHR communication significantly improves post-circumcision monitoring.
- The system aids in early identification and management of complications like proximal bell migration.
- iEHR utilization can lead to reduced complications and optimized patient care.
Objective:
To assess the outcomes of office-based circumcision performed using Plastibell devices in infants, utilizing the MyChart interactive electronic health record (iEHR) system to monitor the progress and identify potential complications.
Methods:
This is a prospective cohort study conducted between March 2021 to April 2022 on all infants undergoing office based Plastibell circumcision. Parents were encouraged to submit concerns via MyChart and to submit photos if the ring has not fallen by post-procedure day 7. Telehealth or in-person clinic visits were then made accordingly. Postoperative complications were collected and compared with existing literature.
Results:
Of the 234 consecutive infants, the average age was 33 days (9-126 days) and the average weight was 4.35 kg (2.5-7.25 kg). A total of 170 parents (73%) responded to MyChart messages. Fourteen (6%) complications necessitating local intervention were identified: excessive fussiness (1), bleeding (2), ring retention (11) including 2 incomplete skin division requiring repeat dorsal block and surgical completion, fibrinous adhesion (3), and proximal ring migration (6). The photo and messages submitted through iEHR facilitated early patient return for intervention. Additionally, 17 parents submitted photos which were expected postprocedural findings and were reassured through iEHR, thus omitting unnecessary return visits. The 2 patients with incomplete skin division occurred early in the series using the included cotton ties. Subsequent procedures were performed with double 0-Silk ties (n = 218) without similar finding.
Conclusion:
The interactive utilization of iEHR communication in the post-circumcision period identified proximal bell migration and bell trapping, allowed earlier intervention and reduced complications.
Level Of Evidence:
Level 1.
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