W. G. Lee1, D. P. Puapong1,2, R. K. Woo1,2, S. M. Johnson1,2 1University Of Hawaii,John A. Burns School Of Medicine,Honolulu, HI, USA 2Kapi’olani Medical Center For Children,Honolulu, HI, USA
Introduction: High surgical volume for both surgeons and hospital systems has been linked with improved outcomes for complex pediatric surgical problems, yet the current number of accredited pediatric surgeons (PS) necessarily means case volumes per surgeon are diminishing nationally in complex pediatric surgery. Referral of complex patients to centralized high volume referral centers is one solution, but has high costs to families, hospital systems, and insurers especially in areas of geographic isolation. We therefore sought to review our experience in a geographically isolated setting where a surgical team approach has been used to improve surgeon volume as well as team/system experience.
Methods: As a surgical group we incorporated a surgical team approach to complex pediatric surgical cases six years ago. We obtained IRB approval to review our PS index case volume experience to date. We then compared our surgeon experience to published surgical volumes for complex pediatric surgical cases.
Results: A surgical team approach (2/3 BC surgeons working as co-surgeons or assistant) was used in the majority of cases for TEF/EA (77%), CPAM (73.5%), cloaca (75%), anorectal malformation (43.6%) biliary atresia (77.8%), Hirschsprung’s disease (51.9%), CDH (67.6%), robotic choledochal cyst (100%), and complex oncology (adrenal tumors, neuroblastoma, Wilms tumor and Hepatoplastoma surgery) (85-100%). Surgeon case exposure for all surgeons/all index pediatric surgical cases was above the published national median for pediatric surgeons, except for in splenic operations. Over the 5-year period, all surgeons were exposed to a high volume of studied index pediatric surgery cases when contrasted to published experience.
Conclusion: A surgical team approach to complex pediatric surgery exposes pediatric surgeons to higher complex case volumes and varieties. This model has implications for geographically isolated and smaller hospitals that specialize in pediatric surgical care and impacts resource allocation, systems development, and workforce allocation in pediatric surgery.