RESUMO
Organization of healthcare strongly differs between European countries and results in country-specific requirements in postgraduate medical training. Within the European Union (EU), the European Board of Anaesthesiology has set recommendations of training for the Specialty of Anaesthesiology including standards for Postgraduate Medical Specialist training including a description for providing service in pediatric anesthesia. However, these standards are advisory and not mandatory. Here we aimed to review the current state and associated challenges of pediatric anesthesia training in Europe. We report an important country-specific variability both in training and regulations of practice of pediatric anesthesia in the EU and in the United Kingdom. The requirements for training in pediatric anesthesia varies between nothing specified (Belgium) or providing anesthesia with direct supervision to a minimum of 50 cases below 5 years of age (Germany) to 3-6 month clinical practice in a specialized pediatric hospital (France). Likewise, the regulations for providing anesthesia to children varies from no regulations at all (Belgium) to age specific requirements and centralization of all children below 4 years of age to specified centers (United Kingdom). Officially recognized pediatric anesthesia fellowship programs are not available in most countries of Europe. It remains unclear if and how country-specific differences in pediatric anesthesia training are associated with clinical outcomes in pediatric perioperative care. There is converging interest and support for the establishment of a European pediatric anesthesia curriculum.
RESUMO
BACKGROUND: Failure to discharge home after day-case procedures has a negative impact on patients, families, and hospital finances. There are currently no national paediatric data on the incidence and causes of unplanned admission. We determined the incidence of unplanned admissions after paediatric day-case anaesthesia, and identified risk factors leading to unplanned admission. METHODS: During a 6 week period (in October and November 2017), all children aged 16 yr or under receiving general anaesthesia without an inpatient bed on arrival were included. Hospital, surgical, and procedural details; anonymised patient characteristic data; and anaesthetic and surgical experience were collected by local Paediatric Anaesthesia Trainee Research Network coordinators. A mixed-effects binary logistic regression model with backward selection was used to determine variables associated with unplanned admission. RESULTS: Ninety three hospitals across the UK and Ireland participated. There were 25 986 cases, of which 640 were unplanned admissions. The independent risk factors for unplanned admission were ASA-physical status (PS) (ASA-PS 3/4 vs ASA-PS 1; odds ratio [OR]: 2.80 [95% confidence interval {CI}: 2.07-3.77]), duration of procedure (OR: 1.04 [95% CI: 1.03-1.05]), and surgical specialty (vs ear, nose, and throat [highest caseload specialty]: cardiology OR: 1.89 [95% CI: 1.15-3.06], orthopaedics/trauma OR: 0.91 [95% CI: 0.69-1.18], and general surgery OR: 0.59 [95% CI: 0.46-0.77]). The commonest reasons for admission were unexpected surgical complexity, pain, postoperative nausea and vomiting, and late finish. CONCLUSIONS: Paediatric patient physical status, some types of surgery and duration of procedure were associated with unplanned day-surgery admissions. Unexpected surgical complexity and patient discomfort in recovery were common factors.
