The Provision of Acute Pediatric Surgical Care by Adult Acute Care General Surgeons

Abstract

Background At our hospital, acute surgical care of children aged 6 and older is managed by adult acute care surgeons. Previously published data from a 10-year experience with this model demonstrated no differences in outcomes when compared with pediatric surgical benchmark data. This study assesses for the effects of a learning curve in the care of pediatric patients by comparing outcomes of patients treated in the first three years with those treated in the last 3 years during a 10-year experience with this model. Design This was a retrospective study of pediatric patients aged 6 and older who underwent an emergent or urgent, nontrauma surgical procedure by a general surgeon. Data was obtained via chart review and descriptive statistics were compared between patients operated on between January 1, 2009-January 1, 2012 and January 1, 2016-January 1, 2019. Results In all, 208 cases were performed in the early cohort and 192 cases in the late cohort. Appendectomy was the most common procedure in both intervals (88% early, 94.8% late). Although there was a significant decrease in open procedures in the later cohort (22.6% vs 4.7%, P < .001), there was no significant change in disease-specific complications or negative appendectomies. No consults to a fellowship-trained pediatric surgeon were required during either time period, although one was available if needed. Conclusions Our data demonstrated a decrease in the number of open procedures in the later cohort. This may be due to an increased comfort level with pediatric laparoscopy over time. However, no significant changes in outcomes were observed. This study supports that acute care general surgeons can provide comparable care to pediatric patients within this age demographic and that although a learning curve, appears to exist with respect to pediatric laparoscopy, it is insignificant in terms of its effect on overall outcomes.

Laparoscopy in the Evaluation of Blunt Abdominal Injury in Level-I and II Pediatric Trauma Centers

“…Prior reports have suggested that favorable attitudes to laparoscopy can be developed within institutions through specialized courses, especially those involving simulation-based training. 36-38 A previous center reported a marked decrease in laparotomy and increase in laparoscopy in dealing with pediatric abdominal trauma as the surgical teams became familiar with the hospital’s new minimally invasive surgery capability. 27…”

“…Prior reports have suggested that favorable attitudes to laparoscopy can be developed within institutions through specialized courses, especially those involving simulation-based training. [36][37][38] A previous center reported a marked decrease in laparotomy and increase in laparoscopy in dealing with pediatric abdominal trauma as the surgical teams became familiar with the hospital's new minimally invasive surgery capability. 27 Laparoscopy for pediatric patients has many purported benefits including avoidance of a non-therapeutic laparotomy, decreased hospital LOS, as well as improved longand short-term morbidity and mortality.…”

Shortages of Care and Medical Devices Affecting the Pediatric Patient Population

“…36 The COVID-19 pandemic has placed strains on the health care workforce and there is evidence that clinicians are reducing their hours and retiring early in response to burnout. 37 The literature describes many possible solutions for this potential shortage of trained pediatric staff, such as clinician cross training within an institution among adult and pediatric practitioners, 38,39 knowledge sharing among specialized practitioners like child psychologists, [40][41][42] telemedicine consultation for rural and remote areas, 43 primary care providers taking on specialist roles, 44 and encouraging institutions to support clinicians who choose to work in pediatric specialties with added incentives. 45 Additional supports for the mental health of practising clinicians may also be helpful in addressing chronic clinician burnout.…”