Neonatal surgery in New South Wales--what is performed where?

The aim of this study was to describe what surgical procedures are performed in the neonatal period in New South Wales (NSW) and where they are performed.

Population-based descriptive study was conducted in NSW in a 2-year period from July 1, 1996 to June 30, 1998, inclusive, using information from the NSW Health Department's Inpatient Statistics Collection. All neonates undergoing major surgery (excluding circumcisions) in NSW.

In the first 4 weeks of life, 990 (0.6%) neonates underwent surgery. The most common surgical procedures were gastrointestinal, cardiovascular, hernia, genitourinary, and neurosurgical. Frenotomy accounted for 5% of all surgical procedures. Whereas 75% of neonatal surgery (including 88% of gastrointestinal and 97% cardiovascular surgery) occurs in children's hospitals, only 13% of the babies requiring surgery are born in the co-located obstetric hospitals. Perinatal centers accounted for 5.3% of surgery; urban hospitals for 8.4%; rural hospitals, 5.5%, and private hospitals, 6.4%. The mortality rate in the neonatal period was 3.0% overall.

This is the first review of major neonatal surgery in Australia and provides baseline data for future comparisons. Whereas most neonates had surgery in a children's hospital, few of them were born in the most appropriate place, the co-located obstetric hospital. Parents should be informed of the level of institutional surgical expertise and be involved in the decision-making regarding the place of surgery for their infant. Parents and children have a right to expect the best possible results.