M. Piacquadio2, E. Ward6, L. Goodman3, A. Wang5, E. Ameh4, S. W. Bickler1 1Rady Children’s Hospital/ UC San Diego,Department Of Pediatric Surgery,San Diego, CA, USA 2Western University Of Health Sciences College Of Osteopathic Medicine Of The Pacific,Pomona, CA, USA 3UC Davis Medical Center,Department Of Surgery,Davis, CA, USA 4National Hospital,Division Of Pediatric Surgery,Abuja, FCT, Nigeria 5Naval Medical Center San Diego,Department Of Surgery,San Diego, CA, USA 6UC San Diego,Department Of Surgery,San Diego, CA, USA
Introduction: An estimated 2 billion children worldwide do not have access to safe surgical care. To begin addressing this critical gap in surgical care, a consortium of providers, institutions and other stakeholders formed the Global Initiative for Children’s Surgery (GICS) in 2016. GICS is in the process of identifying optimal resources for children’s surgical care for different types of facilities in low- and middle-income countries (LMICs). An important unanswered question is which procedures should be done at different levels of care. The goal of this research was to create a list of emergency and essential children’s surgical procedures that can be preformed safely at the primary referral hospital level in LMICs, and to estimate the impact this limited list of procedures might have on the overall surgical need.
Methods: To identify a list of emergency and essential children’s surgical procedures we reviewed Surgical Care For Children: A Guide For Primary Referral Hospitals (Macmillan Publishers, 2011). This handbook includes life saving and/or commonly performed procedures that are not complex, and that can be safely performed by medical officers or general surgeons after brief training. To estimate the impact this list of procedures might have on the total need for children’s surgical care we compared the Macmillan generated list to the surgical procedures recorded in comprehensive children’s surgical database from The Gambia (West Africa). This prospective database contains detailed information on all children aged less than 15 years who were treated for surgical conditions at a government referral hospital in Banjul over a 29-month period (Bull WHO 2000; 78:1330-6).
Results: Surgical Care for Children describes 39 emergency and essential surgical procedures. Procedures on this list treat a wide spectrum of childhood surgical conditions—including the most common injuries (e.g., burns and fractures), selected congenital anomalies (e.g., inguinal hernia and clubfoot), and infections requiring surgery (e.g., abscesses, osteomyelitis and septic joints). The Macmillan generated list of emergency and essential surgical procedures covered 496 of the 798 (62.2%) surgical procedures recorded Gambian surgical database.
Conclusion: Our data suggests that the majority of childhood surgical conditions in LMICs could be treated by a limited number of emergency and essential surgical procedures delivered at the primary referral hospital level. Improving surgical care for children at primary referral hospitals could improve access for children with surgical conditions; decrease the burden at higher levels of care, and likely decrease cost. Future research should focus on the economic and public health impact of providing a pediatric focused package of children’s surgical care at primary referral hospitals in LMICs, and the best strategy for implementation.