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))To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Newborn Circumcision Techniques.Am Fam Physician. 2020; 101: 680-685https://doi.org/10.1007/978-1-4471-2858-8_9
- A contemporary snapshot of circumcision in US children’s hospitals.J Pediatr Surg. 2020; 55: 1134-1138https://doi.org/10.1016/j.jpedsurg.2020.02.031
- Rates of Adverse Events Associated with Male Circumcision in U.S. Medical Settings, 2001 – 2010.JAMA Pediatr. 2014; 168: 625https://doi.org/10.1001/JAMAPEDIATRICS.2013.5414
- Plastibell circumcision of 2,276 male infants: a multi-centre study.Pan Afr Med J. 2016; 23: 1-8https://doi.org/10.11604/pamj.2016.23.35.7841
- The effect of inpatient versus outpatient location on postoperative healthcare utilization after neonatal circumcision.J Pediatr Surg. 2022; 57: 1072-1075https://doi.org/10.1016/j.jpedsurg.2022.01.052
- Broadening candidate office circumcision patients: A comparison of outcome in children based on age and weight.J Pediatr Urol. 2022; 18: 91.e1-91.e6https://doi.org/10.1016/j.jpurol.2021.11.003
- Circumcision of Privately Insured Males Aged 0 to 18 Years in the United States.Pediatrics. 2014; 134: 950-956https://doi.org/10.1542/peds.2014-1007
- Gomco vs. plastibell office circumcision: No difference in overall post-procedural complications and healthcare utilization.J Pediatr Urol. 2021; 17: 85.e1-85.e7https://doi.org/10.1016/j.jpurol.2020.11.019
- Recognizing the Benefit of Telemedicine Before and After COVID-19: A Survey of Pediatric Surgery Providers.J Surg Res. 2021; 267: 274https://doi.org/10.1016/J.JSS.2021.05.019
- The value of telemedicine for the pediatric surgery patient in the time of COVID-19 and beyond.J Pediatr Surg. 2021; 56: 1305https://doi.org/10.1016/J.JPEDSURG.2021.02.018
- Does “MyChart” Benefit “My” Surgery? A Look at the Impact of Electronic Patient Portals on Patient Experience.J Urol. 2020; 204: 760-768https://doi.org/10.1097/JU.0000000000001090
Harting MT, Wheeler A, Ponsky T, et al. Telemedicine in pediatric surgery 2018. https://doi.org/10.1016/j.jpedsurg.2018.04.038.
- A unique service in UK delivering Plastibell® circumcision: Review of 9-year results.Pediatr Surg Int. 2007; 23: 45-48https://doi.org/10.1007/s00383-006-1805-6
Article info
Publication history
Accepted:
January 16,
2023
Received:
January 13,
2023
Publication stage
In Press Accepted ManuscriptFootnotes
☆None of the authors have any conflict of interest.
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
