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.

Keywords

surgical procedures - certification - education - medical - child

• References

• 1 VIDFELT G. Centralization of thoracoplasty in tuberculosis therapy [Article in Undetermined Language]. Sven Lakartidn 1951; 48 (28) 1741-1744
• 2 Papageorgiou AN, Masson M, Shatz R, Gelfand MM. Specialized perinatal care: impact on perinatal mortality. Can Med Assoc J 1977; 116 (05) 506-507
• 3 Karlberg I. Further centralization of pediatric heart surgery is recommended [Article in Swedish]. Lakartidningen 1994; 91 (17) 1686 , 1691
• 4 Lundström NR, Berggren H, Björkhem G, Jögi P, Sunnegârdh J. Centralization of pediatric heart surgery in Sweden. Pediatr Cardiol 2000; 21 (04) 353-357
• 5 Smith ER, Butler WE, Barker II FG. Craniotomy for resection of pediatric brain tumors in the United States, 1988 to 2000: effects of provider caseloads and progressive centralization and specialization of care. Neurosurgery 2004; 54 (03) 553-563 ; discussion 563–565
• 6 Nelen SD, Heuthorst L, Verhoeven RHA. , et al. Impact of centralizing gastric cancer surgery on treatment, morbidity, and mortality. J Gastrointest Surg 2017; DOI: 10.1007/s11605-017-3531-x.
• 7 Bendzsak AM, Baxter NN, Darling GE, Austin PC, Urbach DR. Regionalization and outcomes of lung cancer surgery in Ontario, Canada. J Clin Oncol 2017; 35 (24) 2772-2780
• 8 McCormick MC, Shapiro S, Starfield BH. The regionalization of perinatal services. Summary of the evaluation of a national demonstration program. JAMA 1985; 253 (06) 799-804
• 9 Leonhardt J, Kuebler JF, Leute PJ. , et al. Biliary atresia: lessons learned from the voluntary German registry. Eur J Pediatr Surg 2011; 21 (02) 82-87
• 10 Lampela H, Ritvanen A, Kosola S. , et al. National centralization of biliary atresia care to an assigned multidisciplinary team provides high-quality outcomes. Scand J Gastroenterol 2012; 47 (01) 99-107
• 11 Hannan EL, O'Donnell JF, Kilburn Jr H, Bernard HR, Yazici A. Investigation of the relationship between volume and mortality for surgical procedures performed in New York State hospitals. JAMA 1989; 262 (04) 503-510
• 12 Jenkins KJ, Newburger JW, Lock JE, Davis RB, Coffman GA, Iezzoni LI. In-hospital mortality for surgical repair of congenital heart defects: preliminary observations of variation by hospital caseload. Pediatrics 1995; 95 (03) 323-330
• 13 Norwood WI, Dobell AR, Freed MD, Kirklin JW, Blackstone EH. Intermediate results of the arterial switch repair. A 20-institution study. J Thorac Cardiovasc Surg 1988; 96 (06) 854-863
• 14 Stark J. Glenn Lecture. How to choose a cardiac surgeon. Circulation 1996; 94 (9, Suppl) II1-II4
• 15 Roos Jr LL, Cageorge SM, Roos NP, Danzinger R. Centralization, certification, and monitoring. Readmissions and complications after surgery. Med Care 1986; 24 (11) 1044-1066
• 16 Luft HS. Regionalization of medical care. Am J Public Health 1985; 75 (02) 125-126
• 17 Permanence des soins en établissements de santé (PDSES) | Agence régionale de santé Ile-de-France. Available at: https://www.iledefrance.ars.sante.fr/permanence-des-soins-en-etablissements-de-sante-pdses-0 . Accessed August 20, 2017
• 18 Code de la santé publique-Article L6112–2. Code de la santé publique. Available at https://www.legifrance.gouv.fr/affichCodeArticle.do?cidTexte=LEGITEXT000006072665&idArticle=LEGIARTI000031929266&dateTexte=&categorieLien=id
• 19 Schmiedeke E, de Blaauw I, Lacher M. , et al. Towards the perfect ARM center: the European Union's criteria for centers of expertise and their implementation in the member states. A report from the ARM-Net. Pediatr Surg Int 2015; 31 (08) 741-745
• 20 Borer JG, Vasquez E, Canning DA, Kryger JV, Mitchell ME. An initial report of a novel multi-institutional bladder exstrophy consortium: a collaboration focused on primary surgery and subsequent care. J Urol 2015; 193 (5, Suppl) 1802-1807
• 21 Schneider A, Blanc S, Bonnard A. , et al. Results from the French National Esophageal Atresia register: one-year outcome. Orphanet J Rare Dis 2014; 9: 206
• 22 Bastard F, Bonnard A, Rousseau V. , et al. Thoracic skeletal anomalies following surgical treatment of esophageal atresia. Lessons from a national cohort. J Pediatr Surg 2017; DOI: 10.1016/j.jpedsurg.2017.07.013.
• 23 Chardot C, Buet C, Serinet MO. , et al. Improving outcomes of biliary atresia: French national series 1986-2009. J Hepatol 2013; 58 (06) 1209-1217
• 24 Davenport M, De Ville de Goyet J, Stringer MD. , et al. Seamless management of biliary atresia in England and Wales (1999-2002). Lancet 2004; 363 (9418): 1354-1357
• 25 Davenport M, Ong E, Sharif K. , et al. Biliary atresia in England and Wales: results of centralization and new benchmark. J Pediatr Surg 2011; 46 (09) 1689-1694
• 26 Serinet MO, Broué P, Jacquemin E. , et al. Management of patients with biliary atresia in France: results of a decentralized policy 1986-2002. Hepatology 2006; 44 (01) 75-84
• 27 Holschneider AM, Hutson JM. Anorectal malformations in children: embryology, diagnosis, surgical treatment, follow-up. Springer Science & Business Media; 2006
• 28 Hopper AN, Jamison MH, Lewis WG. Learning curves in surgical practice. Postgrad Med J 2007; 83 (986) 777-779
• 29 van der Steeg HJJ, Schmiedeke E, Bagolan P. , et al. European consensus meeting of ARM-Net members concerning diagnosis and early management of newborns with anorectal malformations. Tech Coloproctol 2015; 19 (03) 181-185
• 30 Spitz L. Oesophageal atresia. Orphanet J Rare Dis 2007; 2: 24
• 31 Sfeir R, Bonnard A, Khen-Dunlop N. , et al. Esophageal atresia: data from a national cohort. J Pediatr Surg 2013; 48 (08) 1664-1669
• 32 Crile Jr G. How to keep down the risk and cost of surgery. Inquiry 1981; 18 (02) 99-101
• 33 Nickerson RJ, Colton T, Peterson OL, Bloom BS, Hauck Jr WW. Doctors who perform operations. A study on in-hospital surgery in four diverse geographic areas (first of two parts). N Engl J Med 1976; 295 (17) 921-926