Rural pediatric surgery
1Department of Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA.
Insights
Regionalization of pediatric surgery can be costly. Rural surgeons, with training and telemedicine, can manage more pediatric surgical cases locally, improving outcomes and reducing expenses.
Area of Science:
- Pediatric Surgery
- Healthcare Systems
Background:
- Published studies advocate for regionalizing pediatric surgery, transferring all children to specialized centers.
- This approach, while improving quality, incurs significant costs for hospitalization and families.
Purpose of the Study:
- To evaluate the role of well-trained rural surgeons in providing pediatric surgical care.
- To explore the potential for rural facilities to manage a broader range of pediatric surgical conditions.
Main Methods:
- Review of outcome studies supporting pediatric surgery regionalization.
- Analysis of the capabilities of rural surgeons and community hospitals with adequate resources and training.
- Consideration of support mechanisms like telemedicine consultation.
Main Results:
- Local community facilities achieve comparable outcomes for straightforward pediatric emergencies like appendicitis.
- Rural surgeons, with enhanced training and support, can manage more complex cases, including pyloric stenosis and single-system trauma.
- Early recognition and treatment in rural settings can improve patient condition prior to transfer for definitive care.
Conclusions:
- A collaborative pediatric surgery system linking rural and community facilities can effectively manage a spectrum of conditions.
- Optimizing rural surgical capacity can provide high-quality care while potentially reducing overall costs and family burden.
Abstract:
Published outcome studies support regionalization of pediatric surgery, in which all children suspected of having surgical disease are transferred to a specialty center. Transfer to specialty centers, however, is an expensive approach to quality, both in direct costs of hospitalization and the expense incurred by families. A related question is the role of well-trained rural surgeons in an adequately resourced facility in the surgical care of infants and children. Local community facilities provide measurably equivalent results for straightforward emergencies in older children such as appendicitis. With education, training, and support such as telemedicine consultation, rural surgeons and hospitals may be able to care for many more children such as single-system trauma and other cases for which they have training such as pyloric stenosis. They can recognize surgical disease at earlier stages and initiate appropriate treatment before transfer so that patients are in better shape for surgery when they arrive for definitive care. Rural and community facilities would be linked in a pediatric surgery system that covers the spectrum of pediatric surgical conditions for a geographical region.
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