Department of Pediatric Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Seoul, Korea.
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Korean Med Sci. 2021 May 10;36(18):e116. doi: 10.3346/jkms.2021.36.e116.
In the past, general surgeons (GSs) without a pediatric surgical subspecialty often performed surgery on children and, even now, GSs are performing many pediatric surgeries. We aimed to investigate the involvement of pediatric surgeons (PSs) and GSs in pediatric surgery, compare the outcomes of surgery in the neonatal intensive care unit (NICU), and estimate the appropriate PS workforce in Korea.
We used surgical data from the National Health Insurance Service database that was collected from patients under the age of 19 years in hospitals nationwide from January 2002 to December 2017. In this database, we found 37 hospitals where PSs worked by using the index operation (congenital diaphragmatic hernia, esophageal atresia, hypertrophic pyloric stenosis, Hirschsprung's disease, abdominal wall defect, jejunoileal atresia, malrotation, anorectal malformation, and biliary atresia). It was assumed that the surgery in the 37 hospitals was performed by PS and that the surgery in other hospitals was performed by GS. Mortality was analyzed to compare the outcomes of acute abdominal surgery in the NICU. We estimated the number of PS currently needed in Korea for each situation under the assumption that PS would perform all operations for the index operation, main pediatric diseases (index operation + gastroesophageal reflux disease, choledochal cyst, inguinal hernia, and appendicitis), acute abdominal surgery in the NICU, and all pediatric surgeries. Additionally, we estimated the appropriate number of PS required for more advanced pediatric surgery in the future.
The number of pediatric surgeries from 2002 to 2017 increased by 124%. Approximately 10.25% of the total pediatric surgeries were performed by PSs, and the percentage of the surgery performed by PSs increased from 8.32% in 2002 to 15.92% in 2017. The percentage of index operations performed by PSs annually was 62.44% in average. It was only 47.81% in 2002, and increased to 88.79% in 2017. During the last 5 years of the study period, the average annual number of surgeries for main pediatric diseases was approximately 33,228. The ratio of the number of surgeries performed by PS vs. GS steadily increased in main pediatric diseases, however, the ratio of the number of surgery performed by PS for inguinal hernia and appendicitis remained low in the most recent years. The percentage of the number of acute abdominal surgery performed by PS in the NICU was 44% in 2002, but it had recently risen to 89.7%. After 30 days of birth, mortality was significantly lower in all groups that were operated on by PS, rather than GS, during the last 5 years. In 2019, 49 PSs who were under the age of 65 years were actively working in Korea. Assuming that all pediatric surgeries of the patients under the age of 19 years should be performed by PS, the minimum number of PS currently required was about 63 if they perform all of the index operations, the main pediatric surgery was about 209, the NICU operation was about 63, and the all pediatric surgeries was about 366. Additionally, it was determined that approximately 165 to 206 PS will be appropriate for Korea to implement more advanced pediatric surgery in the future.
The proportion of the pediatric surgery performed by PS rather than GS is increasing in Korea, but it is still widely performed by GS. PSs have better operative outcomes for acute abdominal surgery in the NICU than GSs. We believe that at least the index operation or the NICU operation should be performed by PS for better outcome, and that a minimum of 63 PSs are needed in Korea to do so. In addition, approximately 200 PSs will be required in Korea in order to manage main pediatric diseases and to achieve more advanced pediatric surgery in the future.
过去，没有小儿外科学专科的普通外科医生（GS）经常为儿童做手术，即使现在，GS 仍在进行许多小儿外科手术。我们旨在调查小儿外科医生（PS）和 GS 在小儿外科手术中的参与情况，比较新生儿重症监护病房（NICU）中的手术结果，并估计韩国适当的 PS 劳动力。
我们使用了国家健康保险服务数据库中的手术数据，该数据是从 2002 年 1 月至 2017 年 12 月全国各医院年龄在 19 岁以下的患者中收集的。在该数据库中，我们通过索引手术（先天性膈疝、食管闭锁、肥厚性幽门狭窄、先天性巨结肠、腹壁缺陷、空肠回肠闭锁、肠旋转不良、肛门直肠畸形和胆道闭锁）找到了 37 家有 PS 工作的医院。假设这 37 家医院的手术都是由 PS 完成的，而其他医院的手术则是由 GS 完成的。我们分析了死亡率，以比较 NICU 中急性腹痛手术的结果。我们假设 PS 将为索引手术、主要儿科疾病（索引手术+胃食管反流病、胆总管囊肿、腹股沟疝和阑尾炎）、NICU 中的急性腹痛手术和所有儿科手术进行所有手术，以此来估计韩国目前每个情况下所需的 PS 数量。此外，我们还估计了未来更先进的儿科手术所需的适当 PS 数量。
2002 年至 2017 年，小儿外科手术数量增加了 124%。大约 10.25%的儿科手术是由 PS 完成的，而 PS 完成的手术比例从 2002 年的 8.32%增加到 2017 年的 15.92%。PS 每年进行的索引手术比例平均为 62.44%。2002 年仅为 47.81%，2017 年上升至 88.79%。在研究期间的最后 5 年，每年主要儿科疾病的手术数量约为 33228 例。在主要儿科疾病中，PS 与 GS 进行的手术数量比例稳步增加，然而，腹股沟疝和阑尾炎的手术数量比例在最近几年仍然较低。在 NICU 中由 PS 进行的急性腹痛手术比例在 2002 年为 44%，但最近已上升至 89.7%。出生后 30 天，所有由 PS 而非 GS 进行手术的组的死亡率均显著降低，在过去 5 年中，PS 组的死亡率均显著低于 GS 组。2019 年，韩国有 49 名年龄在 65 岁以下的 PS 医生正在积极工作。假设所有 19 岁以下患者的儿科手术都应由 PS 进行，那么如果他们进行所有的索引手术，则目前至少需要 63 名 PS，主要儿科手术需要 209 名，NICU 手术需要 63 名，所有儿科手术需要 366 名。此外，我们确定，为了在未来实施更先进的儿科手术，韩国大约需要 165 到 206 名 PS。
韩国由 PS 而非 GS 进行的小儿外科手术比例正在增加，但仍由 GS 广泛进行。PS 为 NICU 中的急性腹痛手术提供了比 GS 更好的手术结果。我们认为，为了获得更好的结果，至少应该由 PS 进行索引手术或 NICU 手术，韩国至少需要 63 名 PS 来完成这项工作。此外，为了管理主要儿科疾病并在未来实现更先进的儿科手术，韩国大约需要 200 名 PS。
