Surgical Pediatric Patients Should Be Admitted Under Pediatric Surgeon Care
Surgical pediatric patients requiring admission should be under the care of a pediatric surgeon, not a general pediatrician, as this directly impacts surgical outcomes including mortality and length of stay.
Age-Based Admission Criteria
All patients 5 years or younger requiring surgical care must be cared for by a pediatric surgeon 1, 2. This is an absolute recommendation from the American Academy of Pediatrics that should guide admission decisions.
For children older than 5 years, the decision depends on:
- Complexity of the surgical condition 1
- Presence of comorbidities that increase operative risk 1, 2
- Type of surgical procedure required 1
High-Risk Patients Requiring Pediatric Surgeon Admission
The following patients must be admitted under pediatric surgeon care regardless of age:
- Infants and children with medical conditions increasing operative risk (congenital heart disease, prematurity) undergoing even common procedures like hernia repair 1, 2
- All patients requiring minimally invasive procedures (laparoscopy, thoracoscopy) 1, 2
- Seriously injured children who should be transferred to pediatric trauma centers 1
- Children with solid malignancies requiring surgical management 1
Evidence Supporting Pediatric Surgeon Admission
Mortality outcomes are significantly better when children are operated on by surgeons who preferentially treat pediatric patients. In cardiothoracic surgery, surgeons in the lowest quartile of pediatric specialization had 2.61 times increased odds of mortality compared to the highest quartile (p<0.01), and in general surgery, there was a 2.15-fold increase in mortality odds (p=0.04) 3.
Length of stay is also affected by surgeon specialization. Comparing least to most specialized surgeons, length of stay increased by 1.14 days for cardiothoracic surgery (p=0.02), 0.58 days for neurosurgery (p=0.04), and 0.23 days for otolaryngology (p=0.02) when children were not cared for by pediatric specialists 3.
Role of the Pediatrician
While the pediatric surgeon should be the admitting physician for surgical patients, pediatricians play a critical role in medical co-management, particularly for:
- Managing underlying medical conditions 1
- Coordinating multidisciplinary care 4
- Providing continuity of care before and after surgical intervention 5
The pediatrician should remain involved as a consultant but not as the primary admitting service for surgical conditions.
Critical Pitfalls to Avoid
Do not admit young surgical patients under general pediatric care with surgical consultation only. The pediatric surgeon must be the primary service to ensure appropriate perioperative management, surgical decision-making, and complication recognition 1, 2, 3.
Do not use arbitrary age cutoffs beyond the 5-year threshold without considering individual patient factors, as surgical complexity and comorbidities matter more than age alone in older children 1, 6.
Ensure adequate surgeon volume and expertise. General surgeons caring for pediatric patients should have completed a minimum 6-month pediatric surgery rotation and maintain sufficient annual case volume 1. However, this still does not replace the need for pediatric surgeon care in high-risk cases 3, 7.