Feasibility and Efficiency of Pediatric Outpatient Cystoscopy: A Step Out of the Operating Room
Frank J. Penna, M.D., Abby Varghese, RN(EC), NP-PHC, Katharine Williams, RN (EC), NP-Paeds, Hissan Butt, B.S., Martin A. Koyle, M.D., Armando J. Lorenzo, M.D..
The Hospital for Sick Children, Toronto, ON, Canada.
BACKGROUND: Awake cystoscopy is routinely performed in the adult ambulatory setting, while pediatric cystoscopy is most commonly performed in the operating room (OR), particularly in younger children. Cystoscopy in the OR necessitates additional anesthetic risk to the child, is time consuming, and expensive. We hypothesized that selective cystoscopy in the ambulatory setting is feasible and results in higher satisfaction and lower costs.
METHODS: All older children and adolescents requiring cystoscopy at our institution within a one-year period (2014-2015) were offered the option of in-clinic versus OR cystoscopy for diagnosis, stent removal or intravesical botulinum toxin injection. Parameters such as age, gender, procedure time, and total clinic time, were reviewed. The patients were administered a survey assessing their level of satisfaction with the experience and their preference for scheduling future outpatient procedures, if indicated.
RESULTS: Thirty children underwent cystoscopy in the outpatient setting. The mean age was 12 years, with 18 male and 12 female patients. Anxiolytic medication was requested by 87% of the patients. The mean procedure time was 22 minutes and mean total clinic time was 131 minutes, as compared to 240 minutes (the mean in-hospital time for cystoscopy in the OR). The mean cost was $217 (CAD), compared to the estimated cost of cystoscopy in the OR ($1016 CAD). Over 95% of patients either strongly preferred or preferred the procedure in the ambulatory setting.
CONCLUSIONS: Outpatient cystoscopy in children is safe and feasible and translates to improvements in patient satisfaction and overall efficiency and availability, while minimizing costs. This option should be considered and offered to older children and adolescents.
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