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Are general paediatric surgery outcomes comparable between district general hospital and regional referral centres?
1Morriston Hospital, Swansea, UK.
Insights
Paediatric surgery in district general hospitals (DGHs) shows favorable complication rates. This study supports continued training and delivery of general paediatric surgery within DGHs, aligning with UK guidelines.
Area of Science:
- Paediatric Surgery
- Surgical Outcomes
- Hospital Quality Improvement
Background:
- Declining numbers of paediatric surgeons in the UK.
- Guidelines exist for paediatric surgery provision in District General Hospitals (DGHs).
- Limited data on acceptable outcomes and complication rates for elective paediatric operations.
Purpose of the Study:
- To record complication rates for general paediatric surgery at a DGH.
- To compare these rates with published literature and current guidelines.
- To assess the viability of paediatric surgery provision in DGHs.
Main Methods:
- Retrospective audit of paediatric urology operations (November 2006 - May 2010).
- Included: orchidopexy, laparoscopy for undescended testes, herniotomy, circumcision.
- Complications identified through audit records, clinic letters, and A&E attendance.
Main Results:
- 306 operations were analyzed: 125 orchidopexies, 28 laparoscopies, 41 herniotomies, 51 circumcisions.
- Overall post-operative complication rate was 4.5%.
- Most common complications were testicular atrophy and infection; no intra-operative complications occurred.
Conclusions:
- Complication rates in this DGH are comparable to published data and guidelines.
- Findings support the continued training and delivery of general paediatric surgery in DGH settings.
- Paediatric surgery can be safely provided in DGHs, meeting established standards.
Introduction:
This study recorded the complication rates for general paediatric surgery undertaken in our district general hospital (DGH) and compared them with the limited amount of data published in this field. There has been a gradual diminution in the numbers of general paediatric surgeons throughout the UK. The Royal College of Surgeons of England has produced guidelines to safeguard the provision of paediatric surgery in DGHs. There are minimal data on the acceptable outcomes and complication rates for elective general paediatric operations.
Methods:
The following operations undertaken by the paediatric urologist in our unit between November 2006 and May 2010 were scrutinised: orchidopexy, laparoscopy for undescended testes, herniotomy and circumcision. The results were compared to those in the literature and current guidelines. Complications were recorded via audit records, clinic letters or records of attendance at the accident and emergency department.
Results:
A total of 306 paediatric operations (125 orchidopexies, 28 laparoscopies, 41 herniotomies and 51 circumcisions) were undertaken over the 42-month study period. Only 4.5% of cases experienced post-operative complications. The majority of these were testicular atrophy and infection. There were no intra-operative complications.
Conclusions:
In our DGH the complication rates for general paediatric operations compare favourably with those set out by the literature and guidelines, which support the training and delivery of general paediatric surgery within DGHs.