The ethical and practical considerations of non-attendance at paediatric neurosurgery appointments

OBJECTIVE: To describe the ethical and practical considerations for parents and caregivers in the context of non-attendance at paediatric neurosurgery appointments at a tertiary neurosurgical unit. MATERIALS AND METHODS: Retrospective review of 1,944 paediatric neurosurgery appointments performed by a single consultant between 2009 and 2024 at the University Hospital of Wales, Cardiff, and Morriston Hospital, Swansea. DNA rates were analysed by year and by appointment type. RESULTS: The non-attendance rate across the 15-year period was 14%, with follow up appointments having a higher DNA rate (14.5%) than new appointments (12.3%), although this difference did not reach statistical significance (p = 0.29). The highest annual overall DNA rate recorded was 19.4%, and the lowest was 3.3%. The Median annual DNA rate was 15.5%. CONCLUSION: Non-attendance at paediatric neurosurgery outpatient appointments is common. It may lead to suboptimal patient care and constitutes a significant cost burden upon paediatric neurosurgery departments. Structural and practical barriers to parents' and carers' ability to attend outpatient appointments should therefore be identified and addressed at an individual unit level, which may improve patient care and generate significant cost-savings. Incorporating carers' perspectives into future research is essential to identify the barriers affecting appointment attendance and to guide the development of tailored interventions to reduce DNA rates.