The Pediatric Surgical Team: a Model for Increased Surgeon Index Case Exposure

Area of Science:

• Pediatric Surgery
• Surgical Outcomes
• Healthcare Systems

Background:

• National trends show decreasing pediatric surgeon case volumes for complex procedures.
• High surgical volume is generally linked to better patient outcomes.
• Geographically isolated settings face unique challenges in maintaining surgical expertise.

Purpose of the Study:

• To evaluate the impact of a surgical team approach on pediatric surgeon exposure to complex cases.
• To assess the feasibility of this model in a geographically isolated setting.
• To compare in-house surgeon experience with national benchmarks.

Main Methods:

• Implemented a surgical team approach (co-surgeons/assistant surgeons) for complex pediatric cases starting in 2010.
• Reviewed institutional data on surgeon index case volumes.
• Compared experienced volumes against published national median volumes for pediatric surgeons.

Main Results:

• The surgical team approach was utilized in the majority of complex cases, including tracheoesophageal fistula, biliary atresia, and pediatric oncology.
• Surgeon index case exposure exceeded national medians for most complex pediatric surgical procedures studied.
• An exception was noted for splenic operations compared to published national experience.

Conclusions:

• A collaborative surgical team model can help maintain adequate index case volumes for pediatric surgeons.
• This approach is beneficial for sustaining surgical competence in isolated practices and low-volume hospitals.
• The model offers valuable insights for pediatric surgical systems development and workforce planning.