Influence of sub-specialty surgical care on outcomes for pediatric emergency general surgery patients in a low-middle income country

•Adult-managed patients had higher complications (OR [95%CI]: 5.42 [2.10–14.00]).•Adult-managed patients had longer average LOS (7.98 vs. 5.61 days, p < 0.01).•39.8% fewer complications expected if all patients managed by pediatric surgery.•An 8.2% decrease in LOS expected if all patients managed by pediatric surgery.•Resources needed for pediatric surgery parallel to adult general surgery teams.

BackgroundWhether adult general surgeons should handle pediatric emergencies is controversial. In many resource-limited settings, pediatric surgeons are not available. The study examined differences in surgical outcomes among children/adolescents managed by pediatric and adult general surgery teams for emergency general surgical (EGS) conditions at a university-hospital in South Asia.MethodsPediatric patients (<18y) admitted with an EGS diagnosis (March 2009–April 2014) were included. Patients were dichotomized by adult vs. pediatric surgical management team. Outcome measures included: length of stay (LOS), mortality, and occurrence of ≥1 complication(s). Descriptive statistics and multivariable regression analyses with propensity scores to account for potential confounding were used to compare outcomes between the two groups. Quasi-experimental counterfactual models further examined hypothetical outcomes, assuming that all patients had been treated by pediatric surgeons.ResultsA total of 2323 patients were included. Average age was 7.1y (±5.5 SD); most patients were male (77.7%). 1958 (84.3%) were managed by pediatric surgery. The overall probability of developing a complication was 1.8%; 0.9% died (all adult general surgery). Patients managed by adult general surgery had higher risk-adjusted odds of developing complications (OR [95%CI]: 5.42 [2.10–14.00]) and longer average LOS (7.98 vs. 5.61 days, p < 0.01). 39.8% fewer complications and an 8.2% decrease in LOS would have been expected if all patients had been managed by pediatric surgery.ConclusionPediatric patients had better post-operative outcomes under pediatric surgical supervision, suggesting that, where possible in resource-constrained settings, resources should be allocated to promote development and staffing of pediatric surgical specialties parallel to adult general surgical teams.