Requirements for Pediatric General Surgery Clearance
Pediatric patients requiring surgical care should be referred to a pediatric surgeon, especially those 5 years or younger, as they have specialized training in the surgical treatment of children. 1
Patient Selection Criteria
Age-Based Considerations
- Infants (0-1 year): Should be managed by a pediatric surgeon, especially for any surgical procedure
- Children (2-12 years): Those 5 years or younger should be managed by a pediatric surgeon
- Adolescents (13-18 years): May be managed by general surgeons for certain procedures, but complex cases should still be referred to pediatric specialists
Medical Conditions Requiring Pediatric Surgical Specialist
- Children with medical conditions that increase operative risk (e.g., congenital heart disease, preterm birth)
- Ex-premature infants less than 60 weeks post-menstrual age (gestational age plus chronological age)
- Children with solid malignancies
- Children requiring minimally invasive procedures (laparoscopy, thoracoscopy)
- Children with severe OSA requiring tonsillectomy/adenoidectomy
Pre-operative Assessment Requirements
Medical Evaluation
- Review of medical history with focus on:
- Anesthesia risks
- Previous surgical complications
- Current medications and allergies
- Underlying conditions requiring special management
Laboratory Testing
- Routine laboratory testing is NOT recommended for healthy children undergoing low-risk procedures 2
- Targeted testing based on specific conditions:
- Hemoglobin levels for suspected anemia
- Sickledex tests for patients at risk
- Coagulation studies using HEMSTOP questionnaire to identify coagulation disorders 2
- Pregnancy test for postmenarchal adolescents on day of surgery
Physical Examination Focus
- Identification of airway anomalies that could interfere with intubation
- Evaluation of cardiac, respiratory, neurologic, and fluid status
- American Society of Anesthesiologists (ASA) risk classification
Specialist Referral Guidelines
When to Refer to Pediatric Surgeon
- All patients 5 years or younger requiring surgical care
- Patients with serious injuries (after stabilization at local hospital)
- Patients requiring minimally invasive procedures
- Patients with solid malignancies
- Patients with medical conditions increasing operative risk
When to Refer to Other Pediatric Specialists
- Pediatric Urologist: For urological conditions, disorders of sex development
- Pediatric Neurosurgeon: For neurosurgical conditions, traumatic head/spine injuries
- Pediatric Otolaryngologist: For complicated infections requiring surgery of ear, nose, sinuses, pharynx
- Pediatric Plastic Surgeon: For congenital malformations, burns, trauma to hand
Facility Requirements
- Hospitals should have guidelines on lower age limits and medical comorbidities they will accept for pediatric day surgery 1
- Appropriate facilities, equipment, and staff training for pediatric care
- District General Hospitals can provide care for otherwise healthy children having simple procedures
- Tertiary pediatric centers for complex procedures and children with complex comorbidities
Common Pitfalls to Avoid
- Failing to recognize conditions requiring specialist care
- Routine ordering of unnecessary laboratory tests for healthy children
- Inadequate preparation of child and family for surgery
- Not considering home environment, distance from hospital, and parents' ability to manage post-operative care
- Neglecting psychological preparation for anxious children
By following these guidelines, appropriate pediatric surgical clearance can be obtained to ensure optimal outcomes for pediatric patients requiring surgery.