Parental Decisional Satisfaction After Hypospadias Repair In The United Kingdom

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 knowing 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. Also, to determine the feasibility of obtaining meaningful data via 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 was maximum regret. Results There were 340 (37%) responses. Median age at primary procedure was 16 (IQR 13-20) months. No DR (score=0) was detected in 186 (55%[95%CI49-60]) respondents however moderate-to-severe decisional regret (score = 26-100) was seen in 21(6.2%[95%CI3.6-8.7]) 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 post-operative 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 or not were similar. This work is limited by surgeons submitting their own data on complications and there is also 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.