Pediatric surgery in The Netherlands

Evaluation of the regional distribution of the pediatric surgery workforce and surgical load in Brazil

Objective

The purpose of this study is to examine the regional distribution of the pediatric surgery workforce and the expected local demand for pediatric surgical procedures in Brazil.

Methods

We collected data on the pediatric surgical workforce, surgical volume, Gross Domestic Product per capita, and mortality for gastrointestinal tract malformations (MGITM) across the different regions of Brazil for 2019.

Results

Data from the Federal Medical Council reported 1515 pediatric surgery registries in Brazil, corresponding to 1414 pediatric surgeons (some pediatric surgeons are registered in more than one state), or 2.4 pediatric surgeons per 100 000 children 14 years of age and younger. There were 828 men and 586 women. The mean age was 51.5±12.8 years, and the mean time from graduation was 3.4±5.7 years. There is a higher concentration of pediatric surgeons in the wealthier Central-West, South, and Southeast regions. Individual surgical volume ranged from 88 to 245 operations/year (average 146 operations/year) depending on the region. Of these, only nine (6.1%) were high-complexity (including neonatal) operations. MGITM tended to be higher in the poorer North and Northeast regions than in other regions of Brazil.

Conclusions

Our findings suggest significant disparities in the surgical workforce and workload across Brazil related to socioeconomic status. Regions with an increased surgical workforce were associated with lower MGITM. The average number of complex operations performed annually by each pediatric surgeon was considerably low. Strategic investment and well-defined health policies are imperative to enhance the quality of surgical care in the different regions of Brazil.

Level of evidence

Retrospective review; level IV.

Pediatric Surgical Research Output in Germany in the Last 30 Years - An Assessment and International Comparison of Three Dedicated Paediatric Surgical Journals

Purpose: Research output of once-leading countries in surgical journals is decreasing despite an overall increase of scientific publications by 8% per year. We aimed to assess research outputs of German, Dutch, and Israeli pediatric surgeons in dedicated pediatric surgical journals in order to get insight into trends in pediatric surgical research. Methods: We collected bibliographic information on all original articles in the Journal of Pediatric Surgery, European Journal of Pediatric Surgery, and Pediatric Surgery International in 1985-1988, 2000-2003, and 2015-2018 that had a German, Dutch or Israeli last author from a department of pediatric surgery. Citation counts were obtained from the Web of Science. Results: Research output of German pediatric surgery decreased from 19 manuscripts in 1988 (0.1/surgeon/year) to eight manuscripts in 2017 (0.02/surgeon/year), whereas those of the Netherlands increased from two manuscripts in 1985 (0.08/surgeon/year) to 12 manuscripts in 2016 (0.3/surgeon/year). The declining German research output negatively correlated with increasing numbers of specialist pediatric surgeons for total (τ = -0.54; P = 0.0156) and manuscripts per surgeon (τ = -0.79; P = 0.0001), resulting in a negative trend over time (χ² = 11.845, P = 0.0006). Analyses of citation patterns revealed that manuscripts by Dutch pediatric surgeons and those published in the Journal of Pediatric Surgery had higher absolute citation counts than the reference category of a German manuscript in the European Journal of Pediatric Surgery. Age-corrected citation rates resembled this result by increasing from 2000 to 2003 ( x ˜ = 0.799, range: 0-3.368) to 2015-2018 ( x ˜ = 2, range: 0-5) (P = 0.035) for the Netherlands. Assessment of manuscript types revealed that the proportion of prospective studies increased in the German sample (χ² = 5.05, P = 0.0246), but remained the lowest among the comparators. Surprisingly, the proportion of non-clinical manuscripts from Germany also increased over time (χ² = 4.001, P = 0.0455), whereas it remained constant in both the Netherlands and Israel. Conclusion: German pediatric surgical research output decreased in the last thirty years based on the sample of dedicated pediatric surgical journals, while Dutch productivity increased. Citation rates-as a measure of scientific impact-were associated and increased with Dutch manuscripts. The involved factors remain to be determined and whether this represents a shift toward other journals or mirrors a general development.

Global comparison of pediatric surgery workforce and training

INTRODUCTION

The number of pediatric surgeons and their distribution vary greatly throughout the world. The purpose of this study is to examine potential influential factors including the length of education and training, pediatric population, birth rate, and gross domestic product (GDP) per capita.

METHODS

An internet search was conducted to determine the duration of education from grade school to pediatric surgery fellowship, number of pediatric surgeons, birth rate, GDP, and population under 15 years of age in 15 countries. The number of pediatric surgeons per million children was correlated with these factors.

RESULTS

The number of pediatric surgeons per million children varied from 0.51 to 29.3. The total length of education from grade school to completion of pediatric surgery training ranged from 23 to 29 years. There was no correlation between pediatric surgeons per million children with the duration of training. The number of pediatric surgeon per million children was inversely correlated with the birth rate. There was a positive correlation between the GDP per capita and pediatric surgeons per million children.

CONCLUSION

There is a tremendous variability in pediatric surgeons around the world. There appears to be a significant shortage of pediatric surgeons in countries with a high birth rate and low GDP per capita.

Trends in children's surgery in England

It is important to plan for the future provision of paediatric surgery and anaesthesia