Telemedicine for the pediatric preoperative assessment during the COVID-19 pandemic: Evaluating patient and provider satisfaction.

The COVID-19 pandemic has presented unprecedented challenges in delivering healthcare to surgical patients. To avoid delays in patient care while still minimizing COVID-19 infection risk to patients and providers, anesthesiology preoperative clinics were presented with the opportunity to implement telemedicine to assess patients' risks prior to surgery. This study explores patient and provider satisfaction with video-based telemedicine preoperative clinic visits during the COVID-19 pandemic via a patient and provider satisfaction survey. A vast majority (>93%) of patients expressed overall satisfaction with telemedicine visits. Similarly, >85% of providers agreed with the benefits of and expressed overall satisfaction with the preoperative telemedicine visits. Overall, patient and provider study participants had positive feedback in response to anesthesia preoperative telemedicine visits. Future studies could assess the preference of telemedicine to in-person visits once the fears of COVID-19 spread have been mitigated, as well as an assessment of outcomes comparing telemedicine and in-person visits.

Cost-Effectiveness of Screening Ultrasound after a First, Febrile Urinary Tract Infection in Children Age 2-24 Months.

OBJECTIVE: To estimate the cost-effectiveness of routine, screening renal bladder ultrasound (RBUS) for children age 2-24 months after a first febrile urinary tract infection (UTI), as recommended by the American Academy of Pediatrics. STUDY DESIGN: We developed a decision analytic model that simulates a population of children after a first febrile UTI. The model incorporates the diagnostic utility of RBUS to detect vesicoureteral reflux and genitourinary anomalies. We adopted a health-system perspective, 5-year horizon, and included 1-way and 2-way sensitivity analyses. Costs were inflated to 2018 US dollars, and our model incorporated a 3% discounting rate. We compared routine RBUS after first, febrile UTI compared with routine RBUS after second UTI (ie, control arm). Our main outcomes were recurrent UTI rate and incremental cost per quality-adjusted life-year (QALY). RESULTS: Among children 2-24 months after a first febrile UTI, RBUS had an overall accuracy (true positives + true negatives) of 64.4%. The recurrent UTI rate in the intervention arm was 19.9% compared with 21.0% in the control arm. Thus, 91 patients would need to be screened with RBUS to prevent 1 recurrent UTI. RBUS increases QALYs by +0.0002 per patient screened, corresponding to an incremental cost-effectiveness ratio of $803 000/QALY gained. In the RBUS arm, 20.6% of children would receive unnecessary voiding cystourethrograms compared with 12.2% of children in the control group. CONCLUSIONS: Screening RBUS after a first, febrile UTI in children age 2-24 months does not meet cost-effectiveness guidelines. Our findings support deferred screening until a second UTI.

Scar acceptance after pediatric urologic surgery.

INTRODUCTION: Patients undergo pediatric urologic surgery as infants and young children. OBJECTIVE: The purpose of the study was to evaluate the evolution of surgical scars over several years in order to inform parents and surgeons on the true cosmetic impact of pediatric surgery and evaluate patient scar satisfaction. STUDY DESIGN: This was a cross-sectional study where patients who have undergone urologic surgery at a young age are evaluated years later for scar satisfaction via an abbreviated validated questionnaire. Scar length currently was measured and compared with immediate postoperative scar length to assess for growth. RESULTS: Eighty-two children were evaluated with a median age (interquartile range) at the time of surgery and at the time of the study of 1 year (0.6-3 years) and 7 years (3-11 years), respectively. Pyeloplasty (48.8%), ureteral reimplantation/ureterocele reconstruction (41.5%) and other (9.8%) surgical techniques were included. No bother was reported in 84.0% of families. Surgical approach (robotic/laparoscopic vs. open) did not influence whether families reported very pleased/pleased versus neutral/somewhat bothered attitudes (p = 0.094). At time of surgery median scar length for all open surgical approaches (N = 65) was 4 cm (IQR 4-4.5 cm) and at time of the study scars were 6 cm (IQR 5-8 cm). For laparoscopic incisions, median length at time of surgery was 0.8 cm (IQR 0.8-1.1 cm) and at a mean follow up time of 2.3 years median scar length was 1.1 cm (IQR 1-1.5 cm). By race, Asian experienced the lowest percent change in scar length 0.3%, then Caucasian 0.8%, Latino 1.4% and self-described other ethnicity 2.0%. DISCUSSION: As predicted, scars grow in length over time in either open or minimally surgical approaches. Depending on patient race, scar growth varied. Regardless, survey results did not vary based on surgical approach, type of surgery or race of survey taker Summary figure. CONCLUSIONS: The majority of families are pleased with overall scar appearance after undergoing major pediatric urologic surgery. Scars tend to grow in length overtime with less growth noted in Asian children and flank incisions.