Influence of sub-specialty surgical care on outcomes for pediatric emergency general surgery patients in a low-middle income country.

Creator(s)

Adil A. ShahFollow
Amarah ShakoorFollow
Cheryl K. ZoggFollow
Tolulope A. Oyetunji, Children's Mercy HospitalFollow
Awais AshfaqFollow
Erin M. GarveyFollow
Asad LatifFollow
Robert RivielloFollow
Faisal G. QureshiFollow
Arif MateenFollow
Adil H. HaiderFollow
Hasnain ZafarFollow

Document Type

Article

Publication Date

5-1-2016

Identifier

DOI: 10.1016/j.ijsu.2016.03.007

Abstract

Background: Whether adult general surgeons should handle pediatric emergencies is controversial. In many resource-limited settings, pediatric surgeons are not available. The study examined differences in surgical outcomes among children/adolescents managed by pediatric and adult general surgery teams for emergency general surgical (EGS) conditions at a university-hospital in South Asia.

Methods: Pediatric patients (

Results: A total of 2323 patients were included. Average age was 7.1y (±5.5 SD); most patients were male (77.7%). 1958 (84.3%) were managed by pediatric surgery. The overall probability of developing a complication was 1.8%; 0.9% died (all adult general surgery). Patients managed by adult general surgery had higher risk-adjusted odds of developing complications (OR [95%CI]: 5.42 [2.10-14.00]) and longer average LOS (7.98 vs. 5.61 days, p < 0.01). 39.8% fewer complications and an 8.2% decrease in LOS would have been expected if all patients had been managed by pediatric surgery.

Conclusion: Pediatric patients had better post-operative outcomes under pediatric surgical supervision, suggesting that, where possible in resource-constrained settings, resources should be allocated to promote development and staffing of pediatric surgical specialties parallel to adult general surgical teams.

Journal Title

Int J Surg

Volume

29

First Page

12

Last Page

18

MeSH Keywords

Adolescent; Adult; Asia; Southeastern; Child; Child; Preschool; Developing Countries; Emergency Service; Hospital; Female; General Surgery; Health Resources; Hospital Mortality; Humans; Length of Stay; Male; Outcome Assessment (Health Care); Pakistan; Pediatric Emergency Medicine; Postoperative Complications; Retrospective Studies

Keywords

Surgical sub-specialties; Surgical Outcomes; Emergency Surgery

Recommended Citation

Shah AA, Shakoor A, Zogg CK, et al. Influence of sub-specialty surgical care on outcomes for pediatric emergency general surgery patients in a low-middle income country. Int J Surg. 2016;29:12-18. doi:10.1016/j.ijsu.2016.03.007