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

被引：5

作者：

Shah, Adil A. ^{[1
,2
,3
,4
]}

Shakoor, Amarah ^{[5
]}

Zogg, Cheryl K. ^{[2
,3
]}

Oyetunji, Tolulope ^{[6
]}

Ashfaq, Awais ^{[1
]}

Garvey, Erin M. ^{[1
]}

Latif, Asad ^{[7
,8
]}

Riviello, Robert ^{[2
,3
]}

Qureshi, Faisal G. ^{[9
]}

Mateen, Arif ^{[4
]}

Haider, Adil H. ^{[2
,3
]}

Zafar, Hasnain ^{[4
]}

机构：

[1] Mayo Clin, Div Gen Surg, Phoenix, AZ USA

[2] Harvard Univ, Brigham & Womens Hosp, Sch Med, Ctr Surg & Publ Hlth,Dept Surg, Boston, MA 02115 USA

[3] Harvard Univ, TH Chan Sch Publ Hlth, Boston, MA 02115 USA

[4] Aga Khan Univ, Dept Surg, Stadium Rd,POB 3500, Karachi 74800, Pakistan

[5] W Virginia Univ, Sch Med, Dept Pediat, Charleston, WV 25304 USA

[6] Childrens Mercy Hosp & Clin, Kansas City, MO USA

[7] Johns Hopkins Univ, Sch Med, Dept Anesthesiol & Crit Care Med, Baltimore, MD 21205 USA

[8] Johns Hopkins Univ, Sch Med, Ctr Global Hlth, Baltimore, MD USA

[9] Univ Texas SW Med Ctr Dallas, Dept Pediat Surg, Dallas, TX 75390 USA

来源：

INTERNATIONAL JOURNAL OF SURGERY | 2016年 / 29卷

关键词：

Pediatric surgery; Adult general surgery; Emergency general surgery; Surgical outcomes; Low- and middle-income country; TRAUMA CENTERS; UNITED-STATES; ADULT; CHILDREN; INJURY; MORTALITY; BURDEN; IMPACT; VOLUME;

D O I：

10.1016/j.ijsu.2016.03.007

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

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 (<18y) admitted with an EGS diagnosis (March 2009-April 2014) were included. Patients were dichotomized by adult vs. pediatric surgical management team. Outcome measures included: length of stay (LOS), mortality, and occurrence of >= 1 complication(s). Descriptive statistics and multivariable regression analyses with propensity scores to account for potential confounding were used to compare outcomes between the two groups. Quasi-experimental counterfactual models further examined hypothetical outcomes, assuming that all patients had been treated by pediatric surgeons. 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. (C) 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

引用

页码：12 / 18

页数：7

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