Bethell George S, Hall Nigel J, Battersby Cheryl, Knight Marian, Darlington Anne-Sophie
University Surgical Unit, Faculty of Medicine, University of Southampton, Southampton, UK
Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK.
Arch Dis Child Fetal Neonatal Ed. 2025 Apr 25. doi: 10.1136/archdischild-2025-328480.
To understand why surgical decision-making in necrotising enterocolitis (NEC) is challenging and to explore what is required to optimise this.
Three semi-structured in-person focus groups exploring surgical decision-making in NEC. Reflexive thematic analysis of the focus group transcript was undertaken.
22 consultant participants (15 paediatric surgeons and 7 neonatologists).
Themes addressing what informs, the challenges of and how to improve surgical decision-making in NEC.
10 themes addressed what informs decision-making in NEC, 6 themes addressed why this is challenging and 5 themes explained what is required to address the challenges of decision-making. Themes regarding challenges of decision-making were: diagnostic uncertainty, variable threshold for referral/transfer, lack of continuity of care, absence of clear criteria for surgery, uncertainty surrounding surgery and fear. Subthemes regarding fear were fear of (1) poor clinical outcome, (2) criticism from colleagues and (3) undertaking unnecessary surgery.Themes in all three areas were related to infant, clinician and system-based factors. These included themes regarding indications for surgical intervention, indications for referral and transfer of infants, and reducing variability in practice.
This study identified themes that illuminate the difficulties experienced by neonatologists and surgeons regarding surgical decision-making in NEC. Clinicians of both specialties would welcome changes to current practice focused particularly around standardisation of practice and greater objectivity around several aspects of surgical decision-making. These insights can be used to focus further research and implement practice change around surgical decision-making in NEC with the ultimate aim of facilitating early and accurate decision-making.
了解坏死性小肠结肠炎（NEC）手术决策具有挑战性的原因，并探索优化手术决策所需的条件。
开展三个半结构化的面对面焦点小组讨论，探讨NEC的手术决策。对焦点小组记录进行反思性主题分析。
22名顾问参与者（15名小儿外科医生和7名新生儿科医生）。
涉及NEC手术决策依据、挑战以及如何改进的主题。
10个主题涉及NEC手术决策的依据，6个主题涉及决策具有挑战性的原因，5个主题解释了应对决策挑战所需的条件。关于决策挑战的主题包括：诊断不确定性、转诊/转院阈值不一、护理缺乏连续性、缺乏明确的手术标准、手术相关不确定性和恐惧。关于恐惧的子主题包括对（1）临床预后不佳、（2）同事批评和（3）进行不必要手术的恐惧。所有三个领域的主题都与婴儿、临床医生和系统因素有关。这些主题包括手术干预指征、婴儿转诊和转院指征以及减少实践中的变异性。
本研究确定的主题揭示了新生儿科医生和外科医生在NEC手术决策中所面临的困难。两个专业的临床医生都欢迎对当前实践进行改变，特别是围绕实践标准化以及手术决策几个方面提高客观性。这些见解可用于进一步聚焦研究，并围绕NEC手术决策实施实践变革，最终目标是促进早期准确决策。
