The role of a photographic atlas in reducing unanticipated healthcare utilization following circumcision

C A Ferreri; A Benvenuto; D E Cassidy; L M McGee; V A Gamsarian; S Daignault-Newton; V Ivancic; J M Park; B S Sack; C S Streur; J Wan; K H Kraft

doi:10.1016/j.jpurol.2023.06.029

The role of a photographic atlas in reducing unanticipated healthcare utilization following circumcision

J Pediatr Urol. 2023 Oct;19(5):642.e1-642.e6. doi: 10.1016/j.jpurol.2023.06.029. Epub 2023 Jul 8.

Authors

C A Ferreri¹, A Benvenuto², D E Cassidy³, L M McGee⁴, V A Gamsarian⁵, S Daignault-Newton⁶, V Ivancic⁷, J M Park⁸, B S Sack⁹, C S Streur¹⁰, J Wan¹¹, K H Kraft¹²

Affiliations

¹ University of Michigan Medical School, Ann Arbor, MI, USA. Electronic address: chferrer@med.umich.edu.
² University of Michigan Medical School, Ann Arbor, MI, USA. Electronic address: abenvenu@med.umich.edu.
³ University of Michigan Medical School, Ann Arbor, MI, USA. Electronic address: cdevon@med.umich.edu.
⁴ Department of Urology, Oregon Health & Science University, Portland, OR, USA. Electronic address: mcgeel@ohsu.edu.
⁵ University of Michigan Medical School, Ann Arbor, MI, USA. Electronic address: gamsaria@med.umich.edu.
⁶ Division of Pediatric Urology, Department of Urology, University of Michigan, Ann Arbor, MI, USA. Electronic address: sfaruzzi@med.umich.edu.
⁷ Division of Pediatric Urology, Department of Urology, University of Michigan, Ann Arbor, MI, USA. Electronic address: vesna@med.umich.edu.
⁸ Division of Pediatric Urology, Department of Urology, University of Michigan, Ann Arbor, MI, USA. Electronic address: jmpark@med.umich.edu.
⁹ Division of Pediatric Urology, Department of Urology, University of Michigan, Ann Arbor, MI, USA. Electronic address: bsack@med.umich.edu.
¹⁰ Division of Pediatric Urology, Department of Urology, University of Michigan, Ann Arbor, MI, USA. Electronic address: coshepar@med.umich.edu.
¹¹ Division of Pediatric Urology, Department of Urology, University of Michigan, Ann Arbor, MI, USA. Electronic address: juliwan@med.umich.edu.
¹² Division of Pediatric Urology, Department of Urology, University of Michigan, Ann Arbor, MI, USA. Electronic address: kraftk@med.umich.edu.

PMID: 37481429
DOI: 10.1016/j.jpurol.2023.06.029

Abstract

Introduction: Circumcision is a common procedure that can evoke caregiver anxiety in the postoperative period due to unfamiliarity with the healing process. To mitigate unnecessary healthcare utilization such as phone calls and unanticipated clinic or emergency department (ED) visits, photographic atlases have been developed to better prepare caregivers for the recovery process. The objective of our study is to further investigate the efficacy of a photographic atlas in its ability to decrease postoperative healthcare utilization using an increased sample size and extended study period compared to previous studies.

Materials and methods: In this study, we compared a prospective intervention cohort of patients undergoing circumcision at our institution who received a photographic atlas during postoperative teaching to a retrospective cohort of patients who had not received it. Our primary outcome was unanticipated healthcare utilization, defined as postoperative telephone calls and unanticipated presentations to the urology clinic or ED.

Results: The retrospective no-atlas cohort included 105 patients, and the prospective intervention atlas cohort included 80 patients. Both groups were similar with respect to age (p = 0.47) and other demographics. There was no statistically significant difference in healthcare utilization between the no-atlas and atlas cohort. Specifically, we identified no difference in the number of phone calls to clinic staff (12 [11.4%] vs. 11 [13.8%], p = 0.64) or unanticipated postoperative clinic or ED visits (2 [1.9%] vs. 4 [5.0%], p = 0.41).

Discussion: The use of a photographic atlas as part of caregiver support for circumcision patients did not demonstrate a statistically significant reduction in either postoperative phone calls or clinic/ED visits. The decrease in absolute number of caregiver phone calls was minimal (12-11), with a small increase in follow-up presentations (2-4). The lack of significant change may be due to the already infrequent occurrence of these events following circumcision, as demonstrated by the no-atlas cohort. Other potential advantages of the atlas, such as improved caregiver confidence and satisfaction, may have been present, but were not measured in this study.

Conclusions: Adding to the mixed results of previous studies, these findings do not support that photographic atlases decrease unanticipated healthcare utilization in children undergoing a circumcision. However, utilization was found to be low. Additionally, further studies are needed to determine other significant benefits of this form of education, such as improved caregiver confidence and satisfaction.

Keywords: Circumcision; Patient education; Photographic atlas.

MeSH terms

Ambulatory Care Facilities
Child
Circumcision, Male*
Humans
Male
Patient Acceptance of Health Care
Prospective Studies
Retrospective Studies