Centralized Pediatric Surgery in the Nordic Countries: A Role Model for Europe?

Pakarinen, Mikko P.; Bjørland, Kristin; Qvist, Niels; Wester, Tomas

doi:10.1055/s-0037-1606635

Cited by 17 publications

(4 citation statements)

References 9 publications

(12 reference statements)

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“…Based on the French national registry of BA, this study reports the outcome of one of the largest cohorts of patients with BA worldwide, with one of the longest follow-ups. These BA registries, which allow monitoring of patients' management on a population basis, and help to define public health policies, were created in several countries including Japan (14,15), Taiwan (16), UK (17), The Netherlands (18,19), Switzerland (20), European Nordic countries (21), and Canada (22,23) (Table 2). In the USA, consortia of expert centers like Biliary Atresia Research Consortium or Childhood Liver Disease Research and Education Network publish collaborative studies on BA (24,25).…”

Section: Discussionmentioning

confidence: 99%

Management of Biliary Atresia in France 1986 to 2015

Fanna

Masson

Capito

et al. 2019

J. pediatr. gastroenterol. nutr.

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Objectives: This study analyses the prognosis of biliary atresia (BA) in France since 1986, when both Kasai operation (KOp) and liver transplantation (LT) became widely available. Methods: The charts of all patients diagnosed with BA born between 1986 and 2015 and living in France were reviewed. Results: A total of 1428 patients were included; 1340 (94%) underwent KOp. Total clearance of jaundice (total bilirubin ≤20 μmol/L) was documented in 516 patients (39%). Age at KOp (median 59 days, range 6–199) was stable over time. Survival with native liver after KOp was 41%, 35%, 26%, and 22% at 5, 10, 20, and 30 years, stable in the 4 cohorts. 25-year survival with native liver was 38%, 27%, 22%, and 19% in patients operated in the first, second, third month of life or later, respectively (P = 0.0001). Center caseloads had a significant impact on results in the 1986 to 1996 cohort only. 16%, 7%, 7%, and 8% of patients died without LT in the 4 cohorts (P = 0.0001). A total of 753 patients (55%) underwent LT. Patient survival after LT was 79% at 28 years. Five-year patient survival after LT was 76%, 91%, 88%, and 92% in cohorts 1 to 4, respectively (P < 0.0001). Actual BA patient survival (from diagnosis) was 81%. Five-year BA patient survival was 72%, 88%, 87%, and 87% in cohorts 1986 to 1996, 1997 to 2002, 2003 to 2009, and 2010 to 2015, respectively (P < 0.0001). Conclusions: In France, 87% of patients with BA survive nowadays and 22% reach the age of 30 years without transplantation. Improvement of BA prognosis is mainly due to reduced mortality before LT and better outcomes after LT.

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Section: Discussionmentioning

confidence: 99%

Management of Biliary Atresia in France 1986 to 2015

Fanna

Masson

Capito

et al. 2019

J. pediatr. gastroenterol. nutr.

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“…While discussions have been ongoing for 2–3 decades ( 4 ), centralization in Germany currently only includes diagnoses of biliary atresia, bladder exstrophy, and epispadias ( 2 ), for which the German Society for Pediatric Surgery provides a structured and multidisciplinary care. Northern European countries have taken a pioneering role of centralization in pediatric surgery due to geographical factors ( 5 ) such as low population density, uneven distribution over large areas, and a limited number of children's hospitals. This early realization has led to an increase in caseloads and improvements in all aspects of patient care.…”

Section: Introductionmentioning

confidence: 99%

Centralization as the key survival benefit in acute neonatal surgery

Besendörfer,

Günster,

Linz

et al. 2024

Front. Pediatr.

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IntroductionCentralization of neonatal surgical care for congenital malformations is already under discussion. Acute care of neonatal emergencies in perinatal centers with affiliated hospitals is not uniformly regulated in Germany.Materials and methodsAnalyses are based on acute pediatric surgical care at four affiliated hospitals of a perinatal center. Epidemiologic data and outcome parameters “survival”, “intracerebral hemorrhage”, and “revision of surgical indication” are assessed. Comparison is made between patients receiving surgical treatment at affiliated hospitals (group A) and patients with transfer to the university center for therapy in case of surgical indication for gastrointestinal diseases (group B).Results17 group A-patients are compared to 40 group B-patients. Comparison of epidemiological data reveals no significant differences. There is a survival advantage with transfer to the university center (mortality of 29% in group A vs. 2% in group B, p = 0.007). Intracerebral hemorrhage occurred more frequently in externally treated patients (group A 24% vs. group B 2%, p = 0.024). Surgical indication was revised in 30% of group B at the university center (p = 0.011) with consecutive successful conservative treatment.ConclusionTransfer of patients at the beginning of the acute phase of gastrointestinal diseases is key to optimize the quality of neonatal surgical care. However, larger population studies should confirm the presented results, discuss restricting factors of real care structures and should rule out bias in triage of patients.

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“…These diagnoses account for 110–120 cases per year. The centralisation process was based on the theory that surgery performed in a high‐volume hospital would be associated with improved outcome 2–4 . Increasing hospital and surgeon volume has been associated with improved outcomes in adult patients 5,6 .…”

Section: Introductionmentioning

confidence: 99%

“…hospital would be associated with improved outcome. [2][3][4] Increasing hospital and surgeon volume has been associated with improved outcomes in adult patients. 5,6 A similar relationship has been shown in the paediatric population for biliary atresia and congenital diaphragmatic hernia repair.…”

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confidence: 99%

Swedish registry study showed that 50% of paediatric operations were performed in university hospitals and mortality was low

Pelkonen,

Frykholm,

Enlund

et al. 2023

Acta Paediatrica

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AimTo investigate the distribution of paediatric surgery in various hospitals and to study postoperative risk factors of mortality.MethodsRetrospective registry‐based cohort study of children aged 0–14 years undergoing surgery from 2017 to 2021. Data were extracted from the Swedish Perioperative Registry. A mixed logistic regression was applied for the all‐risk mortality analysis.ResultsA total of 126 539 cases were identified, 50% in university, 36% in county and 14% in district hospitals. The dominating operations were appendectomy in 6667, orchidopexy in 5287, inguinal hernia repair in 4200 and gastrostomy in 1152 children. Among children under 1 year of age or American Society of Anesthesiologists Physical Status classification (ASA‐PS‐Class) 3–5, the majority underwent surgery in university hospitals. The 30‐day mortality in university hospitals was 0.5% and in county hospitals 0%. The proportion of emergency surgery was similar in university and county hospitals. Independent risk factors of mortality were being under 1 year of age, ASA‐PS‐class 4–5, emergency surgery and surgery at university hospitals.ConclusionHalf of all operations in children were performed in university hospitals, with low postoperative mortality despite effective centralisation of high risk patients <1 year of age or ASA‐PS‐Class 3–5.

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Centralized Pediatric Surgery in the Nordic Countries: A Role Model for Europe?

Cited by 17 publications

References 9 publications

Management of Biliary Atresia in France 1986 to 2015

Management of Biliary Atresia in France 1986 to 2015

Centralization as the key survival benefit in acute neonatal surgery

Swedish registry study showed that 50% of paediatric operations were performed in university hospitals and mortality was low

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