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The emerging pattern of pediatric day-care surgery
C R Moir1, G K Blair, G C Fraser
1Department of Surgery, Montreal Children's Hospital, Quebec, Canada.
Insights
Day-care surgery for children is expanding, with increasing numbers of procedures like hernia repairs and head/neck surgeries. However, infants under 3 months, especially premature ones, may require hospital admission due to complications.
Area of Science:
- Pediatric Surgery
- Ambulatory Surgery
Background:
- The use of short-stay surgical facilities for pediatric patients is rising.
- Indications for day-care surgery in children are becoming more varied.
Purpose of the Study:
- To review trends in day-care surgery for children.
- To identify patient groups requiring hospital admission after day-care procedures.
Main Methods:
- Retrospective review of day-care surgeries at British Columbia Children's Hospital (1982-1986).
- Analysis of procedure types, patient demographics, and reasons for admission.
Main Results:
- Significant increases observed in orchidopexies (40%) and head/neck/endoscopic procedures (50%).
- 36 children (1.6%) required admission due to complexity, hemorrhage, or postanesthetic concerns.
- Anesthetic complications were most common in infants under 3 months, particularly those born prematurely.
Conclusions:
- Day-care surgery is increasingly utilized for diverse pediatric procedures.
- Infants under 3 months, especially premature infants, represent a high-risk group that may benefit from hospital admission for surgery.
Abstract:
The utilization of short stay surgical facilities is increasing and indications for day-care surgery for children are becoming more diverse. These trends were observed in a review of day-care surgery performed at British Columbia Children's Hospital during the years 1982 to 1986. During 1984 and 1985, 688 hernia repairs were undertaken, as were 76 anorectal procedures such as anal fistulotomy, drainage of abscesses, etc. In addition, 127 orchidopexies were performed, which indicated a 40% increase when compared with earlier years. Further procedures included the excision of 38 branchial cleft anomalies and 17 salivary gland lesions, as well as the performance of 95 tracheobronchial endoscopies including the removal of 25 foreign bodies. Head and neck and endoscopic procedures now represent 21% of all general surgery day care cases, and have increased by 50% since 1982. Thirty-six children (1.6%) initially brought in for day care surgery required actual admission to the hospital for such reasons as (1) the procedure being more complex than initially anticipated (15 patients); (2) hemorrhage (5 patients); or (3) postanesthetic concern (11 patients). Two thirds of the anesthetic complications were in infants less than 3 months of age. A special subgroup of high-risk infants were identified--the previous premature less than 52 weeks conceptual age. In our opinion, infants who are less than 3 months of age, especially if born prematurely, should be admitted to the hospital for surgery.