The future of paediatric surgery outside specialist paediatric hospitals

Background In Ireland, general surgeons provide paediatric surgical services to patients remote from specialist paediatric units. Aim To review general paediatric surgical services in the Mid-Western Health Board (MWHB) region with a view to informing future policy decisions in Ireland. Methods From 1995 to 2000, the paediatric surgical workload at the Mid-Western Regional Hospital was reviewed. Operations performed, level of operating surgeon, morbidity and mortality were recorded. Results There were 3,166 general paediatric surgical patients cared for by three general surgeons and one urologist, all with paediatric surgical training. There was an increase in day cases (55% to 70%) and operations at which the consultant was the main operator (40% to 67%). There was no mortality and the morbidity rate was less than 1%. Conclusions General paediatric surgery and urology is well provided for in the MWHB by appropriately trained surgeons. Lack of opportunity for surgeons in training to obtain general paediatric surgical experience will put this service at risk as the current cohort of surgeons retire. Expansion in specialist paediatric surgical services, changes in general surgical training to include general paediatric surgery or proleptic appointments may be required.