title: Elective versus routine postoperative clinic appointments after circumcisions performed under local anesthesia.
abstract: OBJECTIVE
  To evaluate a model of elective postoperative clinic appointments after a minor urological procedure and to compare it to the traditional practice of routine appointments.
  
  
  METHODS
  A total of 104 consecutive patients undergoing adult circumcision under local anesthesia were divided into 2 groups; group A (n = 45) received routine postoperative clinic appointments and group B (n = 59) were given the option to make an appointment on an as-needed basis. Both groups received detailed postoperative instructions on the early signs of symptoms of potential adverse events. The 2 groups were compared regarding demographics, clinical profile, postoperative recovery, and outcome.
  
  
  RESULTS
  Group A patients ("routine appointments") were younger (51 vs 60 years, P <.0001) and included fewer African Americans (57.8% vs 78.0%, P <.03) compared to group B patients ("elective appointments"). Postoperative clinic appointments were categorized as unnecessary in 84.4% (38/45) and 71.1% (42/59) of the patients in groups A and B, respectively. Of the remaining 17 patients in group B who elected to make an appointment, only 1 patient (1.7%) had a true procedure-related issue that justified the visit and required management. Overall, there was no statistical difference between the 2 groups with regard to the number of patients with perceived postoperative issues (P = .36).
  
  
  CONCLUSIONS
  The traditional practice of routine clinic appointments after uncomplicated adult circumcision is medically unnecessary and provides little value in the majority of cases. The practice of open access elective postoperative evaluation based on clearly defined clinical criteria is efficacious, safe, convenient, and enhances resource utilization.
authors.affiliation: Department of Urology, Veterans Affairs Medical Center, Atlanta, GA, USA.
authors.forename: Marla J
authors.initials: MJ
authors.lastname: Wardenburg
authors.forename: Ryan W
authors.initials: RW
authors.lastname: Dobbs
authors.forename: Garrett
authors.initials: G
authors.lastname: Barnes
authors.forename: Usama
authors.initials: U
authors.lastname: Al-Qassab
authors.forename: Chad W M
authors.initials: CW
authors.lastname: Ritenour
authors.forename: Muta M
authors.initials: MM
authors.lastname: Issa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D000772:Anesthesia, Local; D001071:Appointments and Schedules; D002944:Circumcision, Male / Q000009:adverse effects; D006300:Health Services Misuse; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data*; D011182:Postoperative Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016896:Treatment Outcome