L. M. Fluke2, J. L. Fitch2, C. S. McEvoy2, W. H. Ward2, R. L. Ricca1 1Naval Medical Center Portsmouth,Pediatric Surgery,Portsmouth, VA, USA 2Naval Medical Center Portsmouth,General Surgery,Portsmouth, VA, USA
Introduction: The American College of Surgeons and American Pediatric Surgical Association partnered to develop a strategy optimizing care of pediatric patients by focusing on available resources. Regionalization of care allows for placement of fellowship-trained surgeons in large medical centers capable of treating referrals from surrounding communities. It is unknown whether diminished exposure during training effects comfort level of general surgeons performing pediatric. Analyzed are differences in training, volume, and operative comfort of military surgeons with pediatric cases and how these data can affect surgical practice and the military mission.
Methods: Surveys were sent to 174 Navy surgeons concerning training, military station, and comfort level with pediatric surgical cases. Forty-seven surveys were returned. Comparisons were made between surgeons at a large, regional military treatment facility (MTF) and those at smaller facilities, training locations, and whether or not they completed fellowship training.
Results: There were no demographic differences between surgeons who did or did not perform pediatric surgeries (Table 1). Of the respondents, 42.5% perform surgical procedures on children; there were not pediatric fellowships at the hospitals where these surgeons underwent residency. There were no differences in reported comfort with pediatric surgical procedures in military and civilian trained surgeons. Fellowship-trained surgeons in a specialty other than pediatric surgery reported performing appendectomies and cholecystectomies in younger children. Comparing regional MTFs to smaller facilities, surgeons at non-MFTs were more likely to do more cholecystectomies in older children (median age 14), however there was a trend toward appendectomies in younger children compared to MTF colleagues (2.5 versus 5 years of age). MTF surgeons reported performing laparoscopic pyloromyotomies more than open pyloromyotomies.
Conclusion: All surgeons reported similar comfort levels with performing pediatric procedures. Smaller facility surgeons reported performing appendectomies in younger children. Further training in any fellowship is associated with surgeons reporting operating on children at a younger age. Identifying general surgeons or surgeons fellowship trained in other specialties comfortable performing pediatric procedures provides the military with opportunities to appoint these surgeons to hospitals where there is not a pediatric surgeon; contributing to high-quality regionalization of care. Surgeons comfortable with performing pediatric procedures can be utilized for humanitarian missions as the need within each country varies and surgeons with a larger operative repertoire may serve more patients.