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Costs and inconvenience to parents of children requiring minor ear surgery

SIR—Not uncommonly, children who present for elective surgery are canceled for a variety of reasons (1). When considering canceling a procedure, the emotional (2) and economic burdens of parents may not be considered (3). These burdens include travel costs, sibling care, and missed work opportunities, among others. We aimed to evaluate these burdens in parents whose children presented for minor elective procedures. We hypothesized that these costs and inconveniences are substantial and warrant recognition. Our Institutional Review Board exempted this adult questionnaire study. The study was explained to eligible parents and verbal consent was obtained. Identifying factors were not collected. Over a 6-month period in 2016, we obtained a convenience sample of 206 parents accompanying 137 children for myringotomy and tube insertion at our main hospital. We asked a series of questions to determine their costs and inconvenience on that day. We excluded nonEnglish-speaking families and children undergoing additional procedures. We found that 68 (49.6%) children were accompanied by one parent and 69 (50.4%) were accompanied by both parents. The mean distance traveled to hospital was 28.4 miles (median 20 miles, maximum 300 miles). Nearly all (94.2%) drove to hospital, with 38% incurring toll costs. One hundred and fifty-four (74.8%) parents missed a workday. Twenty-seven families (19.7%) incurred childcare costs, and 75 families (54.7%) had food costs. Parents were asked how much of an inconvenience it would be if they had to repeat the trip to the hospital if their child’s surgery was canceled. Using a Visual Analog Scale from 0 to 100, with 0 representing no inconvenience and 100 the most imaginable inconvenience, the mean score was 76, with 117 parents (56.8%) ranking the inconvenience between 80 and 100 (Figure 1). These results demonstrate the burden of bringing a child to hospital for day surgery. The majority of parents missed a workday. Many employers do not offer employees paid personal days. These employees are typically in the bottom tiers of their company’s wage distribution (4). These lower pay tier parents must cope with the loss of a paid workday. Twenty-seven parents reported a financial loss on that day. If their cases are canceled and these parents are asked to return to the hospital another day, they would lose two paid workdays. Some families incurred day care costs for siblings, but many of the parents who came alone stated that their child’s other parent was at home watching the sibling(s) and thus unable to come to the hospital for emotional support. Our study is limited to parents of children presenting for minor ear surgery at an urban center. Furthermore, a parent’s subjective feeling about the inconvenience of cancelation may differ if their child’s surgery was canceled due to illness or fasting violation. Ultimately, the overall inconvenience experienced by the families in our study was reflected by the Visual Analog Scale, which skewed toward maximal inconvenience. This comes as no surprise because it is not inconceivable that the parent arranges their day off from work well in advance of their child’s surgery. On the day of surgery they may arise earlier than usual, and their child may be abnormally irritable from hunger. The parent may then need to drop off other children at another location prior to driving to the hospital. The frustration felt by families when their child’s surgery is canceled is considerable, as is evident from our data. We conclude that if there is no evidence-based indication of increased risk in proceeding with anesthesia and surgery for a given case, parental costs and inconvenience should be considered factors (pros vs cons) in the decision to cancel. Figure 1 Visual Analog Scale of inconvenience.