Factors impacting surgical decision making between prenatal and postnatal repair for myelomeningocele. (20th December 2021) - Fabelo, Corrie
Abstract: Objectives: To determine factors influencing patients to choose prenatal or postnatal repair of their child's myelomeningocele (MMC) when both treatment options are offered. Methods: We distributed a retrospective survey via email and social media to parents of children with MMC who were offered both prenatal and postnatal surgery as intervention options. Results: A total of 127 surveys met all inclusion criteria. The majority of responders considered partner's opinion (85%), maternal risks of prenatal surgery (71%), and risk for preterm labor (76%) as influencers. Financially, the costs of childcare (39.4% postnatal, 13.8% prenatal, p = 0.002), relocation (57.6% postnatal, 36.2% prenatal, p = 0.019), and travel (51.5% postnatal, 33% prenatal, p = 0.033) were more influential for the postnatal group while insurance coverage (36.4% postnatal, 68.1% prenatal, p = 0.003) was more influential to the prenatal group. Of the medical factors, the consideration of maternal risk for transfusion was different between surgical groups (39.4% postnatal, 18.1% prenatal, p = 0.015). The open responses suggest that both surgical groups found the quality of life for the baby to be significant to their decision‐making. Conclusions: These findings should guide providers to tailor counseling to patient's needs. Comprehensive counseling should include information on financial resources, referral to financial counselors, and psychosocial support services. Key points: What is already known about this topic? Prenatal surgery to repair myelomeningocele has improved outcomes for children based on results of the 2011 MOMs trial Although prenatal surgery is associated with improved outcomes for the fetus some patients still opt for a postnatal repair when eligible for a prenatal repair Patients face considerable challenges when making surgical decisions including familial influences, social influences, and financial influences What does this study add? Individuals who have postnatal surgery may be influenced by non‐medical costs related to surgery, while those who have prenatal surgery may be influenced by insurance coverage of the procedure. Medicaid and private insurance coverage impact the influence of financial factors when making surgical decisions. Expected quality of life is a crucial factor in decision making. Additionally, patients benefit from the availability of resources such as mental health support and housing.