Time to Get on the Bus: Children’s Surgery and Where We Need to Go

Abstract

* Abbreviations: ACS — : American College of Surgeons KID — : Kids Inpatient Database Who should do the operation? Where should the operation be done? After ensuring that their child needs a surgical procedure, these are among the most important questions anxious parents ask. Although factors such as travel distance and insurance requirements play a role in these decisions, the most important consideration is what will be safest and provide the best possible outcome. In this edition of Pediatrics , Somme and colleagues1 give us a view of the current landscape. This view is essential because it is hard to reach a destination if you do not know where you are. Somme et al describe inpatient pediatric surgical case volumes from the Kids Inpatient Database (KID) from 2009. This includes 216 081 procedures performed in children <18 years at either a general hospital or pediatric hospital. The first important observation is that 40% of these operations occurred in general, not pediatric, hospitals. Although it is unlikely that children’s hospitals could quickly absorb this entire volume of pediatric general surgery, even if desired, some continued shift toward children’s hospitals is likely to occur as work-hour restrictions in general surgery residency training programs have mandated less and less exposure to pediatric specialty training. Secondly, Somme et al show that 58% of the pediatric inpatient procedures in general … Address correspondence to Rebecka L. Meyers, Professor of Pediatric Surgery, University of Utah, Primary Children’s Hospital, 100 Mario Capecchi Dr., Salt Lake City, Utah 84103, Phone:801-662-2950, Rebecka.meyers{at}imail.org