VOLUME 28, ISSUE 2

AN UPDATE TO THE PROPOSED NEW STANDARDS FOR CHILDREN’S SURGICAL CARE IN THE US

Priscilla J. Garcia, MD, MHA
Pediatrics Editor

In 2014, the American College of Surgeons (ACS) initially published the first iteration of new consensus guidelines defining the resources that surgical facilities needed to perform operations “effectively and safely” in infants and children (ACS press release March 2014). The Task Force for Children’s Surgical Care, an ad hoc group of invited leaders in relevant disciplines, authored this document after identifying a “mismatch between individual patient needs and available clinical resources for some infants and children receiving surgical care” (Task force 2014).

Representatives of the Regents of the ACS, the Board of Governors and members of the American Pediatric Surgical Association and the board of the Society of Pediatric Anesthesia developed these consensus recommendations over the prior three years with the vision that “every infant and child undergoing surgery in the United States today should receive care in an environment with prospectively defined optimal resources matched to his/her needs.” The group reviewed published data regarding outcomes in children undergoing surgery in specialized versus non-specialized environments. The benefit of the specialized environment was most apparent in higher risk patients: neonates, infants, and inpatients having more complicated procedures such as cardiac surgery.

In 2014, the American College of Surgeons (ACS) initially published the first iteration of new consensus guidelines defining the resources that surgical facilities needed to perform operations “effectively and safely” in infants and children (ACS press release March 2014). The Task Force for Children’s Surgical Care, an ad hoc group of invited leaders in relevant disciplines, authored this document after identifying a “mismatch between individual patient needs and available clinical resources for some infants and children receiving surgical care” (Task force 2014).

Representatives of the Regents of the ACS, the Board of Governors and members of the American Pediatric Surgical Association and the board of the Society of Pediatric Anesthesia developed these consensus recommendations over the prior three years with the vision that “every infant and child undergoing surgery in the United States today should receive care in an environment with prospectively defined optimal resources matched to his/her needs.” The group reviewed published data regarding outcomes in children undergoing surgery in specialized versus non-specialized environments. The benefit of the specialized environment was most apparent in higher risk patients: neonates, infants, and inpatients having more complicated procedures such as cardiac surgery.

Characteristic Level I Level II Level III
Age of patient Any Any >6 months
ASA 1-5 1-3* 1-2*
Multidisciplinary management of comorbidities Multiple medical and surgical specialties; pediatric anesthesiology Typically, single surgical specialties; neonatology; pediatric anesthesiology None
Operations Procedures for major congenital anomalies and complex diseases, including those that are uncommon or require significant multidisciplinary coordination Procedures for common anomalies and diseases that are typically treated by most children’s surgical specialists and that do not require significant multispecialty coordination Common, low-risk procedures typically performed by a single specialty
Ambulatory ASA 1-3
Full term and pre-term infants may be cared for as ambulatory patients based on written guidelines established by the pediatric anesthesiologist in charge of perioperative care; institutional guidelines generally require full-term infants <4 weeks or pre-term infants <50 weeks postmenstrual age to be monitored for >12 hours		 ASA 1-3
Full term and pre-term infants may be cared for as ambulatory patients based on written guidelines established by the pediatric anesthesiologist in charge of perioperative care; institutional guidelines generally require full-term infants <4 weeks or pre-term infants <50 weeks post-menstrual age to be monitored for >12 hours		 Otherwise healthy (ASA 1-2) Age >6 months
Table adapted from “Optimal Resources for Children’s Surgical Care 2015.”

* Emergent procedures in some patients ASA>3 may be appropriate in neonatal patients, such as those with necrotizing enterocolitis. Infants and children with emergent or life-threatening surgical needs and cannot be reasonably delayed for transport should receive initial stabilization and necessary care at the site of presentation.

The CSV committee has participated in several outreach activities to the national Anesthesiology community including presentations at the March 2014 IARS meeting, the annual ASA meeting in October 2015 and has plans to present at the 2016 IARS meeting (Deshpande et al 2016).

The online application – a pre-review questionnaire for centers seeking designation through the CSV – is expected to launch later this year. Undergoing this designation process is voluntary. These standards are meant to prospectively define optimal resources for pediatric patients and match them to his/her anticipated need.

For more specific information about the ACS Optimal Resources for Children’s Surgical Care standards, please visit the ACS website at www.facs.org.

ACS press release March 1, 2016
American College of Surgeons. “Optimal Resources for Children’s Surgical Care.” 2015.
Deshpande JK, Houck CS, Martin L, Flick RP. “American College of Surgeons starts Children’s Surgery Verification and Quality Improvement Program” SPA News. 29 (1), Winter 2016.

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