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Background:
Capital expenses limit availability of operating robots at moderate volume pediatric hospitals. In an effort to provide robotic surgery as a treatment option for our patients, we sought to utilize a daVinci robotic system housed at a financially associated, though geographically distinct, community hospital which offers no pediatric services. We undertook specific measures in order to maintain pediatric focused care and to ensure maximal safety in this unique setting. This was accomplished by utilization of pediatric anesthesia providers, pediatric recovery room nurses, and transfer back to a pediatric hospital for postoperative care. Coordination of these measures was accomplished by a pediatric urology nurse coordinator who also counseled families on perioperative logistics of their child’s surgery. The aims of this study are to assess parental satisfaction with their child’s care as well as to identify any procedural complications in this setting.
Methods:
Prior to our first robotic procedure in January 2012, the coordinated process for offering pediatric robotic surgery was developed. As no validated survey covered our unique aims, we developed a questionnaire based on a 5 point scale (5 representing highly satisfied) that assessed parental satisfaction with various aspects of the process. The questionnaire was administered in the post-operative period via phone by a third party. Patient safety was assessed in a retrospective fashion noting any anesthetic or operative complications. Potential areas of quality improvement were noted. Statistical analysis via T test and ANOVA was performed.
Results:
26 patients (average age of 10.4 years) have undergone robotic surgery to date. The most common procedure was robotic pyeloplasty performed in 24/26 patients. No complications (operative or anesthetic) or open conversions were noted in this cohort. The parents of 22 patients completed the survey which consisted of 12 elements for a maximum score of 60. The average score for all participants was 56.09. There was no significant difference in average satisfaction for the first half of patients treated versus the second half of the patients treated (55.9 vs. 56.3, p>0.05). The questionnaire specifically addressed parental comfort level with pediatric robotic surgery in an adult hospital. Perceived parental comfort level prior to surgery was statistically lower than perceived comfort level after surgery (4.27 vs. 4.64, p=0.008). The questionnaire items with the lowest average score (4.27) were preoperative comfort level and parental satisfaction with transport back to the pediatric hospital though ANOVA testing failed to demonstrate significant variance in the mean element scores (p>0.05). Dialogue with parents revealed that parents not allowed to ride with their child during the transport were the most dissatisfied.
Conclusions:
Performing robotic surgery at an adult-centered hospital can be done safely and with excellent parental satisfaction. Maintaining pediatric-centered care with pediatric anesthesia providers and nurses helps facilitate this process. Quality improvement considerations to increase parental confidence and satisfaction include an increased emphasis on preoperative counseling by a nurse coordinator and allowing continuous parental contact with their child postoperatively (i.e., during transport). With a carefully coordinated process, pediatric robotics can be practiced in non-traditional settings.