Kapi'olani Medical Center for Children, 1319 Punahou St., Honolulu, HI, USA 96826.
Kapi'olani Medical Center for Children, 1319 Punahou St., Honolulu, HI, USA 96826.
J Pediatr Surg. 2019 Sep;54(9):1878-1883. doi: 10.1016/j.jpedsurg.2018.12.018. Epub 2019 Jan 21.
BACKGROUND/PURPOSE: High surgical volume for both surgeons and hospital systems has been linked to improved outcomes for many surgical problems, yet case volumes per pediatric surgeon are diminishing nationally in complex pediatric surgery. We therefore sought to review our experience in a geographically isolated setting where a surgical team approach has been used to improve per-surgeon exposure to index pediatric surgical cases.
As a surgical group, we incorporated a surgical team approach to complex pediatric surgical cases in 2010. We obtained institutional review board approval to review our pediatric surgeon index case volume experience. We then compared our surgeon experience to published surgical volumes for complex pediatric surgical cases.
A surgical team approach (2 or 3 board certified pediatric surgeons/urologists working as co-surgeons or assistant surgeon) was used in the majority of cases for tracheoesophageal fistula/esophageal atresia (77%), congenital pulmonary airway malformation (73.5%), cloaca (75%), anorectal malformation (43.6%) biliary atresia (77.8%), Hirschsprung's disease (51.9%), congenital diaphragmatic hernia (67.6%), robotic choledochal cyst (100%), and complex oncology (adrenal tumors, neuroblastoma, Wilms tumor and Hepatoblastoma surgery) (85-100%). Over the 5-year period, surgeon index case exposure for all index pediatric surgical cases was above the published national median for pediatric surgeons, except for in splenic operations when contrasted to published experience.
A surgical team approach to complex pediatric surgery may help maintain exposure to adequate index case volumes. This model may be useful for maintaining competence in geographically-isolated practice settings and low-volume pediatric hospitals that provide surgical care; the model has implications for systems development and workforce allocation within pediatric surgery.
背景/目的：大量的外科手术经验，无论是外科医生还是医院系统，都与许多外科问题的改善结果相关。然而，在复杂的小儿外科手术中，全国范围内每位儿科外科医生的手术量都在减少。因此，我们试图在一个地理位置孤立的环境中回顾我们的经验，在这个环境中，采用外科团队的方法来提高每位外科医生接触小儿外科手术的机会。
作为一个外科团队，我们在 2010 年采用了一种外科团队的方法来处理复杂的小儿外科病例。我们获得了机构审查委员会的批准，以审查我们的小儿外科医生指数病例量经验。然后，我们将我们的外科医生经验与已发表的复杂小儿外科病例的手术量进行了比较。
在大多数气管食管瘘/食管闭锁（77%）、先天性肺气道畸形（73.5%）、泄殖腔畸形（75%）、肛门直肠畸形（43.6%）、胆道闭锁（77.8%）、先天性巨结肠（51.9%）、先天性膈疝（67.6%）、机器人胆总管囊肿（100%）和复杂肿瘤（肾上腺肿瘤、神经母细胞瘤、威尔姆斯瘤和肝母细胞瘤手术）（85-100%）的病例中，采用了外科团队的方法（2 名或 3 名具有小儿外科医师/泌尿科医师资格的外科医生共同担任主刀或助理）。在 5 年期间，除了与发表的经验相比，在脾手术方面，所有小儿外科指数病例的外科医生指数病例暴露量均高于全国小儿外科医生的中位数。
采用外科团队的方法来处理复杂的小儿外科手术可能有助于保持足够的指数病例量的接触。这种模式可能有助于在地理位置孤立的实践环境和提供外科护理的低容量儿科医院中保持竞争力；该模式对小儿外科内系统开发和劳动力分配具有影响。
4 级
