Pediatric surgeon vs general surgeon: Does subspecialty training affect the outcome of appendicitis?

Silva, Paulo Sérgio Lucas da; Aguiar, Vânia Euzébio de; Waisberg, Jaques

doi:10.1111/ped.12208

Cited by 19 publications

(28 citation statements)

References 18 publications

(100 reference statements)

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“…Two studies (63,282 children) were retrospective analyses of registry-based hospital discharge data. 13 , 18 The other 7 studies (2713 children) concerned specified institutions and were either single-center 12 , 17 or multicenter. 8 , 11 , 14 – 16 Recruitment dates for included studies spanned the period from 1993 to 2012.…”

Section: Resultsmentioning

confidence: 99%

“…No study reported explicitly on criteria that determined whether patients were managed by general surgery teams or pediatric surgery teams – however we think that allocation is likely to have reflected the nature of the on-call team and available resources at any particular time. Most of the studies reported on the proportions of patients who underwent laparoscopic or open appendicectomy procedures 8 , 11 , 12 , 14 , 16 , 17 although these data were not reported in some studies. 13 , 15 , 18 , 19 Few studies reported conversion rates from laparoscopic to open surgery.…”

Section: Resultsmentioning

confidence: 99%

“… 13 , 15 , 18 , 19 Few studies reported conversion rates from laparoscopic to open surgery. 8 , 16 Only 2 studies 8 , 17 specified a single primary endpoint: 1 favored the pediatric surgery group 8 and there was no primary outcome difference in the other. 17 The results of the quality assessment are available in a supplementary table and are also summarized in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

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Systematic Review and Meta-Analysis on the Influence of Surgeon Specialization on Outcomes Following Appendicectomy in Children

et al. 2015

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The aim of this study is to assess the influence of surgeon specialization on outcomes following appendicectomy in children.General surgeons and pediatric surgeons manage appendicitis in children; however, the influence of subspecialization on outcomes remains unclear.Two authors searched Medline and Embase to identify relevant studies. Eligible studies were comparative and provided data on children who had appendicectomy while under the care of general or pediatric surgical teams. Two authors initially screened titles and abstracts and then full text manuscripts were evaluated. Data were extracted by 2 authors using an electronic spreadsheet. Pooled risk ratios and pooled mean differences were used in analyses.We identified 9 relevant studies involving 50,963 children who were managed by general surgery teams and 15,032 children who were managed by pediatric surgery teams. A normal appendix was removed in 4660/48,105 children treated by general surgery units and in 889/14,760 children treated by pediatric units (pooled risk ratio 1.79; 95% confidence interval [CI] 1.26–2.54; P = 0.001). Children managed in general units had shorter mean hospital stays compared with children managed in pediatric units (pooled mean difference −0.70 days; 95%CI −1.09 to −0.30; P = 0.0005). There were no significant differences regarding wound infections, intra-abdominal abscesses, readmissions, or mortality.We found that children who were managed by specialized pediatric surgery teams had lower rates of negative appendicectomy although mean length of stay was longer. Our article is based upon a group of heterogeneous and mostly retrospective studies and therefore there is little external validity. Further studies are needed.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Systematic Review and Meta-Analysis on the Influence of Surgeon Specialization on Outcomes Following Appendicectomy in Children

et al. 2015

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“…A previous study demonstrated that specialized surgeons produce better outcomes than general surgeons after general thoracic surgical procedures [ 25 ]. In another study, adverse events after complicated appendicitis were significantly more prevalent for those who were treated by general surgeons than by pediatric surgeons [ 26 ]. In our study, however, no differences in short-term adverse events or readmission were found between pediatric and nonpediatric orthopedic surgeons.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for complications and readmission after operative fixation of pediatric femur fractures

Momaya

Baker

Gilbert

et al. 2015

Journal of Children's Orthopaedics

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PurposeOperative fixation of pediatric femur fractures with intramedullary implants has grown in popularity in recent decades. However, risk factors for short-term adverse events and readmission have not been well studied.MethodsPediatric patients who underwent intramedullary nailing of a femur fracture between 2012 and 2013 were identified from the American College of Surgeons National Surgical Quality Improvement Program database. Risk factors for any adverse event (AAE) and readmission after intramedullary nailing were evaluated using univariate and multivariate analysis.ResultsA total of 522 pediatric patients who underwent intramedullary nailing of the femur during the study period were identified. The mean age of this patient cohort was 10.2 ± 3.8 years. Review of the cases revealed that 18 (3.4 %) patients had AAE and that 20 (3.8 %) patients were readmitted, of whom 13 (2.5 %) underwent a reoperation. Independent risk factors for AAE were a cardiac comorbidity [odds ratio (OR) 12.7, 95 % confidence interval (CI) 1.5, 103.7], open fracture (OR 10.2, 95 % CI 1.4, 74.4), and prolonged operative time (OR 17.5, 95 % CI 6.1, 50.5). Independent risk factors for readmission were a central nervous system disorder (OR 4.5, 95 % CI 1.3, 16.2) and a seizure disorder (OR 4.9, 95 % CI 1.0, 23.5).ConclusionsThe results of the multivariate analysis suggest that cardiac comorbidities, open fractures, and prolonged operative time increase the risk for AAE and that central nervous system disorders and seizure disorders may increase the risk for readmission. Surgeons should be aware of these risk factors and counsel the families of pediatric patients who undergo intramedullary nailing of femur fractures.

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“…Acute appendicitis is the most common disease requiring emergency surgery, with surgeons performing 81,000 appendectomies annually in the United States 9 . Similarly, in Australia, surgeons perform 27,000 appendectomies every year 4,5,10,11 .…”

Section: Introductionmentioning

confidence: 99%

Optimal Time to Surgery for Patients Requiring Laparoscopic Appendectomy: An Integrative Review

Gardiner¹,

Gillespie²

2016

AORN Journal

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Acute appendicitis is the most common condition requiring emergency surgery worldwide. Although current guidelines recommend prompt appendectomy as the preferred treatment, no time interval for surgery has been indicated. We used an integrative review methodology to critically evaluate evidence on the relationship between time to surgery and hospital length of stay and to identify the ideal time to surgery for patients undergoing appendectomy. We included 14 studies in our synthesis, most of which (n = 9/14, 64%) indicated that longer time delays to surgical intervention increased hospital length of stay for patients presenting with appendicitis. Researchers report that the optimal time for surgery is 24 to 36 hours after symptom onset, or 10 to 24 hours from admission. The results of our review indicate that patient symptoms on presentation may signify advancing pathology and may be more important than the time delay interval in defining surgical priority.

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Pediatric surgeon vs general surgeon: Does subspecialty training affect the outcome of appendicitis?

Abstract: Overall complication rates were similar between PS and GS. Complications were significantly more prevalent in patients with complicated appendicitis who were treated by GS.

Cited by 19 publications

References 18 publications

Systematic Review and Meta-Analysis on the Influence of Surgeon Specialization on Outcomes Following Appendicectomy in Children

Systematic Review and Meta-Analysis on the Influence of Surgeon Specialization on Outcomes Following Appendicectomy in Children

Risk factors for complications and readmission after operative fixation of pediatric femur fractures

Optimal Time to Surgery for Patients Requiring Laparoscopic Appendectomy: An Integrative Review

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