Parental decisional satisfaction after hypospadias repair in the United Kingdom. Issue 2 (April 2020) - ,
Summary: Background: In hypospadias, the aim of surgical treatment is to achieve both desirable functional and cosmetic outcomes; however, complications following surgery are common and 18% of boys require re-operation. In mild degrees of hypospadias, repair may be offered entirely to improve cosmesis, meaning parents should be fully informed of this and the potential for complications, during the consent process. Parents' decision-making may be aided by making them aware of how others in a similar position have felt about the decision that they made for their child. One method of measuring parental satisfaction is decisional regret (DR). Objectives: To assess parental satisfaction following hypospadias surgery in the United Kingdom by assessing DR and to determine the feasibility of obtaining meaningful data via a mobile phone survey. Study design: The National Outcomes Audit in Hypospadias database was commissioned by the British Association of Paediatric Surgeons to capture clinical information from hypospadias repairs. Following ethical approval (16/NW/0819), a text message was sent to mobile numbers in the database inviting participation in a questionnaire incorporating the validated DR scale (DRS). The primary outcome measure was mean DRS score, which was correlated with clinical information, a score of zero indicated no regret and 100 indicated maximum regret. Results: There were 340 (37%) responses. The median age at the primary procedure was 16 (interquartile range 13–20) months. No DR (score = 0) was detected in 186 (55% [95%CI 49–60]) respondents; however, moderate-to-severe DR (score = 26–100) was seen in 21 (6.2% [95%CI 3.6–8.7]) respondents. On multivariate analysis, a distal meatus, a small glans and developing complications requiring repeat surgery were all associated with increased levels of regret (Table). There was no association between DR and cases performed per surgeon. Discussion: Around half of respondents demonstrated no DR and postoperative complications requiring surgery were associated with the highest levels of DR, which is similar to a Canadian study. Lorenzo et al. however found that DR was associated with circumcision, which was undertaken in all boys; however, in this UK study, around a third of boys were circumcised and regret levels between those circumcised and those not circumcised were similar. The limitations of this work include the following: surgeons submitting their own data on complications and there is potential of selection bias between respondents and non-respondents as with any survey. Conclusions: Data from this study can be used to improve pre-operative counselling during the consent process. Smart mobile phone technology can be used successfully to distribute and collect parent-reported outcomes. Summary Table Multivariate linear regression analysis of decisional regret scale score comparing pre-operative characteristics, operative technique and outcomes with adjustment for potential confounders Table Change in DRS score, 95% CI P Increase in age at primary surgery, per month −0.03 (−0.08–0.03) 0.34 Distal meatus 3.3 (0.5–6.2) 0.02 Small glans 3.4 (0.7–6.2) 0.02 Two-stage repair 0.1 (−3.9–4.1) 0.96 Complication not requiring surgery 5.1 (−0.3–10.5) 0.06 Complication requiring further surgery 17.8 (13.0–22.6) <0.001