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Current status of subspecialization in pediatric surgery: A focus on fetal surgery

  • Natalie M. Lopyan
    Correspondence
    Corresponding author at: Division of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA.
    Affiliations
    Division of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
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  • Erin E. Perrone
    Affiliations
    Division of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA

    The North American Fetal Therapy Network (NAFTNet), USA
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  • Samir K. Gadepalli
    Affiliations
    Division of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
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  • Mehul V. Raval
    Affiliations
    Department of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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  • Kuojen Tsao
    Affiliations
    Department of Pediatric Surgery, The McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA

    The North American Fetal Therapy Network (NAFTNet), USA
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  • Barrie S. Rich
    Affiliations
    Division of Pediatric Surgery, Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center, New Hyde Park, NY, USA
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  • on behalf of theAmerican Academy of Pediatrics Section on Surgery Delivery of Surgical Care Committee

      Abstract

      Background/purpose

      Fetal surgery is a growing field within pediatric surgery. We sought to understand practice patterns of pediatric surgeons who subspecialize in fetal surgery.

      Methods

      A survey was sent to all active non-trainee surgeons within the American Pediatric Surgical Association. Respondents were stratified based on self-reported fetal affiliations.

      Results

      Of 1015 surveys, we received 405 responses (40%). Fetal surgery practices were described by 77 self-designated fetal center members. Centers provide prenatal consultation (99%), diagnostic imaging (84%), care/delivery coordination (83%), and/or fetal surgery/procedures (52%). The majority (56%) of fetal programs are directed by surgery and maternal fetal medicine. Pediatric surgeons are represented on the fetal team in 96% of centers. Prenatal consultations are primarily seen by any pediatric surgeon in the group (53%), with the pediatric surgeon on call operating on/caring for the baby postnatally in the majority (64%), regardless of who performed the prenatal consultation. Only 29% of fetal center members performed a fetal operation in the last year. Yearly fetal case numbers vary widely per procedure, with the most common being complex twin procedures and needle-based sclerotherapy.

      Conclusions

      Fetal centers vary by services offered, team composition, and interventions performed, with few surgeons performing a wide range of fetal surgery.

      Level of evidence

      Level III

      Keywords

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      References

        • Moon-Grady AJ
        • Baschat A
        • Cass D
        • et al.
        Fetal treatment 2017: the evolution of fetal therapy centers: a joint opinion from the International Fetal Medicine and Surgical Society (IFMSS) and the North American Fetal Therapy Network (NAFTNet).
        Fetal Diagn Ther. 2017; 42: 241-248
        • McAteer JP
        • LaRiviere CA
        • Drugas GT
        • et al.
        Influence of surgeon experience, hospital volume, and specialty designation on outcomes in pediatric surgery: a systematic review.
        JAMA Pediatr. 2013; 167: 468-475
        • Tuggle CT
        • Roman SA
        • Wang TS
        • et al.
        Pediatric endocrine surgery: who is operating on our children?.
        Surgery. 2008; 144: 869-877
        • Somme S
        • To T
        • Langer JC.
        Effect of subspecialty training on outcome after pediatric appendectomy.
        J Pediatr Surg. 2007; 42: 221-226
        • Borenstein SH
        • To T
        • Wajja A
        • et al.
        Effect of subspecialty training and volume on outcome after pediatric inguinal hernia repair.
        J Pediatr Surg. 2005; 40: 75-80
        • Rich BS
        • Silverberg JT
        • Fishbein J
        • et al.
        Subspecialization in pediatric surgery: results of a survey to the American Pediatric Surgical Association.
        J Pediatr Surg. 2020; 55: 2058-2063
        • Maternal-fetal intervention and fetal care centers
        • Committee Opinion No. 501
        American College of Obstetricians and Gynecologists and American Academy of Pediatrics.
        Obstet Gynecol. 2011; 118: 405-410
        • Moise KJ
        • Johnson A
        • Tsao K.
        Certification process of fetal centers in Texas and developing national guidelines.
        Obstet Gynecol. 2020; 135: 141-147
        • Harrison MR.
        Fetal surgery: trials, tribulations, and turf.
        J Pediatr Surg. 2003; 38: 275-282
        • Berman L
        • Kabre R
        • Kazak A
        • et al.
        Exposure to prenatal consultation during pediatric surgery residency: implications for training.
        J Pediatr Surg. 2016; 51: 131-136