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

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DOI: 10.1016/j.ijsu.2016.03.007


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.

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Int J Surg



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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


Surgical sub-specialties; Surgical Outcomes; Emergency Surgery

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