Between 10% and 18% of paediatric procedures are performed by trained paediatric surgeons (PS) and the remainder by adult general surgeons (GS), with fewer than one PS per million children in low- and middle-income countries. This scoping review searched PubMed, Cochrane, Scopus, Ovid, Web of Science and Google Scholar for original research and systematic reviews published from 2020 onwards that directly compared GS and PS outcomes in paediatric patients and reported measurable clinical outcomes, excluding single-speciality studies without comparison, trainee-only and simulation studies, and case reports or series with fewer than 20 patients. Included studies came from North America (8), Europe (4), Asia (2) and South America (1). Outcomes varied by patient age, with odds ratios of 0.44 (95% CI 0.32 to 0.61) at 1 to 5 years, 0.78 (0.65 to 0.94) at 6 to 12 years and 1.66 (1.23 to 2.24) at 13 to 17 years, while pooled risk ratios were 1.58 (1.21 to 2.07, p=0.001, I2=82.4%) for negative appendicectomy, 1.20 (0.74 to 1.94, p=0.466, I2=96.0%) for overall complications and 0.79 (0.57 to 1.10, p=0.163, I2=84.7%) for 30-day readmission. Narrative synthesis found no significant difference in conversion from laparoscopic to open surgery, although GS were more likely to start with an open approach (22.6% versus 4.7% for early experience). One study reported 68% lower morbidity for high-volume GS than low-volume PS (p<0.005), and another reported GS achieving proficiency after approximately 31 paediatric cases with outcomes subsequently matching those of PS. The review concludes that outcomes are driven more by procedural volume and experience than by speciality, and recommends integrated GS and PS systems, expanded GS training in core paediatric principles, and regionalisation of complex cases to high-volume paediatric centres.
CORE (COnnecting REpositories)
CORE (COnnecting REpositories)