Social Aspects: Sustainability for the Patient, the Family, and the Healthcare System

Abstract

Frailty in children creates a unique challenge for the pediatric surgeon. These children often have several medical problems that require careful attention before surgery. We intend to consider strategies to improve perioperative management of this special needs population.

Frail children should receive surgical care at institutions that offer multidisciplinary, pediatric-centered care. Surgical indication should be a decision made after careful consideration of risks and benefits, keeping in mind that good outcomes likely reflect a conservative approach. Families, as well as primary care providers, play an important role and should always be involved in decision making. Perioperative management involves: (1) preparation of the child and family to face the surgery; (2) preoperative medical optimization to bring patients to their individual optimum level of health; (3) anticipation of problems or concerns and planning with anesthesia team; (4) preparation of the surgical approach considering possible anatomy alterations, favoring minimally invasive techniques, and predicting difficulties; (5) strategies to minimize postoperative pain, enhance early feedings and mobilization for a fast recovery to achieve early discharge; (6) multidisciplinary support of the family throughout the admission and after discharge.

Pediatric surgeons must always offer the best of their knowledge and competence and should have the means to achieve that for the child’s best interest.