Association Between Race and Skin Complications Following Hypospadias Repair in Children
Hasan Jhaveri, MS, Christopher Bayne, MD, Wei Xue, PhD, Romano DeMarco, MD.
University of Florida, Gainesville, FL, USA.
BACKGROUND: Intrinsic differences in the skin of people of color, particularly African Americans, Latinx, and Asians, is associated with a robust inflammatory response following surgery and increased risk for postoperative scarring. The incidence of postoperative skin related complications has been reported to be higher in these racial groups.
METHODS: We performed a retrospective analysis of boys at our institution who had a primary hypospadias repair between 1/2014-1/2019. Demographic information including race was collected and included the following groups: White, African American, American Indian or Alaska Native, Asian, Native Hawaiian or Other, Pacific Islander, Latinx, or other, non-White. We measured skin complication occurrence, which was further categorized by intervention as a nonmedical, minor surgical, or major surgical event.
RESULTS: 141 patients who underwent primary hypospadias surgical repair were included. Mean age at surgery was 16 months. 57% of patients (81/141) were identified as White, 28% (39/141) were African American, 6% (8/141) were Latinx, 3% (5/141) were Asian, and 6% (8/141) were other (non-White). Skin complications occurred in a total of 28 patients (20%) over a period of 5 years. 20 (14%) patients had skin complications treated medically, while 8 (6%) patients required some surgical intervention. Three patients (2%) required minor surgical intervention, while five patients (4%) required major surgical intervention. Of the five patients who required major surgical intervention, none were of white skin color. When comparing the white cohort to the nonwhite cohort, there was no statistically significant difference in incidence of skin complications. However, the nonwhite cohort was associated with more severe skin related complications (p < .05; p = 0.0496).
CONCLUSIONS: Postoperative skin complications following hypospadias repairs in boys are relatively common, occurring in 20% of our patients. The majority of these complications are minor and typically resolve with corticosteroid ointment and time. Nonwhite race was found to be a risk factor for severe postoperative skin complications. These findings warrant consideration of an alternative to Byars flaps in boys with skin of color and limited ventral shaft skin.
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