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Updated: Apr 3, 2026

Intraoperative Video Consultation Following Bile Duct Transection Facilitates Direct OR Transfer for Robotic Hepaticojejunostomy at Tertiary Center

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Patterns of Avoidable Pediatric General Surgical Referrals in a Rural State.

Savannah C Walker¹, Esma Birisci², Deidre L Wyrick¹

¹Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Division of Pediatric Surgery, Arkansas Children's Hospital, Little Rock, Arkansas.

The Journal of Surgical Research

|April 1, 2026

Summary

This summary is machine-generated.

Nearly a quarter of pediatric surgical referrals are avoidable, leading to healthcare inefficiencies. Targeted screening before outpatient visits can improve pediatric specialty care access and resource use.

Keywords:

Avoidable referrals Pediatric surgery Referrals Surgery

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Area of Science:

Pediatric Surgery
Healthcare Management
Health Services Research

Background:

Avoidable referrals for pediatric general surgery lead to inefficient healthcare use and burdens for families.
Characterizing factors associated with avoidable referrals is crucial for optimizing pediatric surgical care access.

Purpose of the Study:

To identify patient and referring provider characteristics linked to avoidable outpatient pediatric general surgical referrals in a rural setting.
To analyze the impact of avoidable referrals on healthcare utilization and patient outcomes.

Main Methods:

Multisite retrospective cohort study of pediatric patients (<18 years) referred for outpatient general surgery.
Defined avoidable referrals as those not requiring in-clinic procedures, imaging, operations, or follow-up within one year.
Employed bivariate and multivariable logistic regression to assess patient and provider factors associated with avoidable referrals.

Main Results:

24% of 5966 referrals were avoidable, with higher rates in younger children (0-3 years).
Umbilical hernia (39% avoidable) and pectus excavatum (46% avoidable) were common and frequently avoidable referrals.
Self-pay status and referrals from emergency medicine providers significantly increased the odds of avoidable referrals (OR 2.5 and 1.8, respectively).
Avoidable referrals had a shorter time from referral to clinic visit (34 vs. 41 days).

Conclusions:

Nearly one-quarter of pediatric general surgery referrals are avoidable, indicating a need for improved referral processes.
Implementing targeted screening before outpatient pediatric general surgical evaluations can enhance access to appropriate specialty care and optimize healthcare utilization.