Paediatric surgical services in remote northern Australia: an integrated model of care
Liam Quinn1, David Read1,2
1Department of Surgery, Royal Darwin Hospital, Darwin, Northern Territory, Australia.
Insights
This study found that children undergoing elective pediatric surgery (orchidopexy or inguinal herniotomy) in rural Australia had outcomes comparable to specialized centers. This integrated care model minimizes family disruption and costs.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Healthcare Delivery Models
Background:
- Paediatric surgical services in rural Australia are provided by general surgeons with paediatric training, supported by visiting paediatric surgeons.
- Transferring elective paediatric cases to tertiary centres has significant social and financial implications for families and the health system.
- This study evaluates clinical outcomes of common paediatric surgeries managed by an integrated rural service.
Purpose of the Study:
- To review clinical outcomes for elective surgery in children managed by an integrated service of general and visiting paediatric surgeons.
- To compare these outcomes with published results from dedicated paediatric centres.
- To assess the viability of a rural integrated surgical care model.
Main Methods:
- Retrospective audit of paediatric patients undergoing surgery at Royal Darwin Hospital and Darwin Private Hospital (2005-2016).
- Inclusion criteria: orchidopexy (age < 5 years) and inguinal herniotomy (age < 1 year).
- Data collected on surgical outcomes and complications.
Main Results:
- Orchidopexy (n=80): 5.5% recurrence, 1.3% severe atrophy, 5.5% total atrophy.
- Inguinal herniotomy (n=65): 1.8% testicular maldescent/atrophy, 0% recurrence.
- Complication rates were equivalent to or slightly higher than published gold standards.
Conclusions:
- The integrated model of paediatric surgical care in rural Northern Territory provides acceptable outcomes.
- This model mitigates the substantial family disruption, cultural, financial, and compliance issues associated with long-distance transfers.
- Equivalent or slightly higher complication rates suggest this model is a viable alternative to centralized paediatric surgical services.
Background:
Surgical services for children in the Northern Territory of Australia are routinely performed by general surgeons with specific paediatric training, supported by paediatric surgeons. In Australasia, indications for appropriate transfer of elective routine surgery in children to tertiary paediatric surgical centres have been contentious. To transfer all elective paediatric cases from rural locations would have significant social and financial consequences for families and the health system. This study reviews clinical outcomes for elective surgery for two common conditions managed by an integrated service of general surgeons and visiting paediatric surgeons, and compares them with published outcomes from paediatric centres.
Method:
A retrospective audit of children undergoing orchidopexy under the age of 5 years or inguinal herniotomy under the age of 1 year at the Royal Darwin Hospital and Darwin Private Hospital between January 2005 and 2016 was conducted.
Results:
During the study period, 66 boys underwent 80 orchidopexies at a mean age of 22.3 months (±20.4 SD). A recurrence rate of 5.5%, severe atrophy rate of 1.3% and total atrophy rate of 5.5% were achieved. Sixty-three children underwent 65 inguinal herniotomies at a mean age of 2.5 months (±4.2). A testicular maldescention and atrophy rate of 1.8% and recurrence rate of 0% was achieved.
Conclusion:
Children managed with this model of care had complication rates equivalent to or slightly higher than published gold standards. Considering the family disruption, cultural, financial implications and threat to compliance that transfer across vast distances entails, this model provides acceptable outcomes.
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