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Outcome assessment of office Plastibell circumcision in infants utilizing interactive electronic health record

      Summary

      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 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). 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, 3 fibrinous adhesion, and 6 proximal ring migration. The photo and messages submitted through iEHR facilitated early patient return for intervention. Additional 17 parents submitted photos which were expected postprocedural findings, and were reassured through iEHR thus omitted 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.

      Keywords

      Abbreviations:

      Interactive Electronic Health Record ((iEHR))
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