Application of a Multidisciplinary Collaboration Model-Supported Structured Home Care in Reducing Postoperative...

Hypospadias is a common congenital anomaly in males and often requires surgical intervention, usually with tubularized incised plate (TIP) urethroplasty. However, postoperative complications such as urethrocutaneous fistula, stenosis, and wound dehiscence remain persistent clinical challenges. Reducing these complications depends not only on surgical approach but also on optimized perioperative and postoperative care pathways, supported by high-quality nursing and timely identification of early warning signs. Therefore, this study aims to investigate the application of multidisciplinary team (MDT) care integrated with a structured home care model in paediatric hypospadias management.

This retrospective study compared postsurgical outcomes in children (aged 1-5 years) with distal hypospadias undergoing primary TIP urethroplasty at Ganzhou People's Hospital between June 2022 and August 2024. Study participants were divided into two groups based on care pathway: MDT combined with a structured home care (intervention group) and a conventional nursing care (control group). Key outcomes assessed were complication rates, urodynamic parameters, postoperative pain levels, caregiver anxiety, and cosmetic outcomes (Hypospadias Objective Scoring Evaluation [HOSE] scores).

The intervention group showed significantly shorter surgery times, lower postoperative pain (Children's and Infants' Postoperative Pain Scale [CHIPPS]), reduced parental anxiety (Self-Rating Anxiety Scale [SAS]) (all p < 0.001). Compared with the control group, the intervention group demonstrated significantly improved HOSE scores at 12 months postoperatively, indicating superior cosmetic outcomes (p < 0.001). At 12 months, the intervention group demonstrated comparatively lower complication rates (14.95% vs. 24.37%), though not statistically significant (p > 0.05). Urodynamic parameters, such as corrected maximum and average flow rates (maximum urinary flow rate corrected for voided volume[cQmax] and average urinary flow rate corrected for voided volume [cQave]), showed gradual recovery but remained lower than baseline (p < 0.05). Multivariate analysis further confirmed that parental anxiety is an independent predictor of postoperative complications (p < 0.001). Mediation analysis revealed that parental anxiety mediated the relationship between care pathway and complication risk (p < 0.001).

The structured home-based nursing model supported by a MDT may be associated with a reduced risk of complications in children after hypospadias repair. This association might be related to improved postoperative pain control and enhanced mental health levels among parents. This model emphasizes collaborative perioperative care and structured support during the postoperative recovery phase. Given that the difference in complication rates has not reached statistical significance, the above results should still be interpreted with caution. Further multi-center studies with larger sample sizes and longer follow-up periods are needed to verify its clinical benefits and elucidate the underlying mechanisms.