French Connection between Specialized and Routine Pediatric Surgical Care

Abstract

Introduction The success of modern pediatric surgery (PS) management has led to the recommendation of regional organization and coordination of PS departments. Although small units may obtain excellent results, there is evidence that a concentration to larger units is advantageous. In France, the centralization of PS has been discussed for the past 15 years. A new organization was finally achieved in 2010. The intent was to assure children prompt access to the level of care appropriate to the degree of their pathologies to improve the outcomes and reduce morbidity and mortality. Methods One of the first pertinent governmental measures was an attempt to centralize the PS departments and encourage the development of connection between specialized PS care and routine PS unit. In this review, we report this coordination through the analysis inside two regional French areas. Results Paris is the first example that illustrates the network between four specialized PS departments and eight local hospitals. The aim of this connection was to improve the safety and quality of pediatric surgical management during the night for emergency issues and in the case of neonatology. The second example is the network that coexists in the west part of France through monthly video conferencing sessions and subspecialization (pediatric urology, pediatric oncology, and pediatric liver surgery). Moreover, a national program aimed at improving the management of patients with rare diseases since 2005. For instance, biliary atresia and anorectal malformation centers are located in two academic centers in Paris and the esophageal atresia center is in Lille. These expert centers allowed performing numerous studies along with international publications, thereby offering a better vision of the natural story of diseases to improve care. Finally, this network is emphasized during medical education from PS residency to the fellowship when trainees have to spend at least 1 year in a local hospital. Conclusion The European legislation calls for multidisciplinary centers treating children with rare diseases and proposes clear and demanding quality criteria. The French experience illustrates some interesting and encouraging aspects of the current trends in PS care. Our results strongly suggest that centralization, specialization, and connections between specialized and routine PS departments can greatly improve management of and outcomes in children treated in our units.

ERNICA Consensus Conference on the Management of Patients with Esophageal Atresia and Tracheoesophageal Fistula: Follow-up and Framework

“…15,36 In France, the available data strongly suggest that centralization, specialization, and connections between specialized and routine pediatric surgical departments can greatly improve management of and outcomes in children. 34 In this study, it was demonstrated that efforts toward further centralization of pediatric surgery have already resulted in reduced morbidity and mortality. 34,38,39 These endeavors should be urgently pursued implementing the mission of ERNICA.…”

“…34 In this study, it was demonstrated that efforts toward further centralization of pediatric surgery have already resulted in reduced morbidity and mortality. 34,38,39 These endeavors should be urgently pursued implementing the mission of ERNICA.…”

“…13 The European legislation calls for multidisciplinary centers treating children with rare diseases and proposes clear and demanding quality criteria. 34 Centralization in surgical patient care is a topic that is increasingly becoming important due to the growing number of reports that the level of care has improved and the number of complications, including mortality, have decreased with an elevation in the number of treated patients per surgeon and center. 14,[34][35][36] Pediatric surgery is a specialty of rare cases and low numbers.…”

“…34 Centralization in surgical patient care is a topic that is increasingly becoming important due to the growing number of reports that the level of care has improved and the number of complications, including mortality, have decreased with an elevation in the number of treated patients per surgeon and center. 14,[34][35][36] Pediatric surgery is a specialty of rare cases and low numbers. 35 It is therefore all the more important to pool expertise and corresponding infrastructure in a specialized center.…”

“…Until today, the optimal way to concentrate on pediatric surgical experience in each European country remains undefined and most likely depends on multiple national features, such as size and distribution of the population, geographical distances, local surgical expertise, organization of the health care system, and political agendas: 15,34,37,38 The architype for centralization in the United Kingdom, for example, is the management of biliary atresia being exclusively managed in three centers. 39 All the Nordic countries (Finland, Norway, Sweden, and Denmark) have a relatively small population making it necessary to concentrate advanced pediatric surgical care to a few specialized centers to ensure adequate caseload and high-quality care.…”