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Paediatric surgery carried out by general surgeons: a rural New Zealand experience
Szelin Peng1, Michael Fancourt, William Gilkison
1Department of General Surgery, Taranaki Base Hospital, Auckland, New Zealand. szelin.peng@gmail.com
Insights
General surgeons in New Zealand manage many paediatric surgical patients, with appendicectomy and inguinal herniotomy being common procedures. Close collaboration with specialist paediatric surgeons is essential for provincial care.
Area of Science:
- Paediatric Surgery
- General Surgery Audit
- Healthcare Delivery
Background:
- Centralization trends in paediatric surgery contrast with the reality of general surgeons managing paediatric cases.
- New Zealand has limited paediatric tertiary centers, necessitating general surgical unit involvement.
- An audit was conducted to assess paediatric surgical patient care in a general surgical unit.
Purpose of the Study:
- To audit paediatric surgical patients admitted to a general surgical unit.
- To evaluate the scope and nature of paediatric surgery performed by general surgeons.
- To inform collaboration strategies between general and paediatric surgical specialists.
Main Methods:
- Prospective data collection over one year (December 2005-2006).
- Standardized pro forma used for all children aged 15 and below presenting to general surgery.
- Analysis of patient demographics, procedures, outcomes, and tertiary transfers.
Main Results:
- 209 admissions (194 children) with a median age of 8 years.
- Common procedures included appendicectomy (35) and inguinal herniotomy (30), with 51% of operations being acute.
- 5% of cases were transferred to tertiary centers for specialized care; complications were infrequent.
Conclusions:
- General surgical departments handle a substantial volume of paediatric surgical cases.
- Approximately half of paediatric admissions required surgery, with a significant proportion being acute.
- Ongoing need for general paediatric surgery in provincial settings underscores the importance of collaboration with specialist paediatric surgeons.
Background:
There are increasing moves towards centralization in paediatric surgery. With only four paediatric tertiary centres in New Zealand, many general surgeons still routinely carry out paediatric surgery. We present an audit of paediatric surgical patients admitted to our general surgical unit.
Methods:
Data were prospectively recorded using a standardized pro forma on all children aged 15 years and below, who presented to general surgery between 11 December 2005 and 11 December 2006.
Results:
There were 209 admissions (194 children); the median age was 8 years (range 6 weeks to 15 years) with 153 (73%) acutes. Male : female ratio was 3:2 and 37 children (18%) were less than 2 years of age. Procedures (n = 119) comprised appendicectomy (35), inguinal herniotomy (30), skin procedures (29), endoscopy (10), testicular (10) and others (5). The commonest acute and elective operations were appendicectomy and inguinal herniotomy, respectively, with 51% of all operations carried out acutely. There were 10 tertiary hospital transfers (5%) for burns (4), pyloric stenosis (3), intussusception (1), neonatal inguinal hernia (1) and pyoderma gangrenosum (1). Median age of transfers was 11 months (range 6 weeks to 14 years). Complications were wound infection (1), postoperative ileus (2) and infarcted ovary (1).
Conclusion:
A large number of children presented to our surgical department. Approximately half required surgery and half of the operations were acute. There is still a significant need for general paediatric surgery in the provinces and hence close collaboration with specialist paediatric surgeons.
