Evaluation of the regional distribution of the pediatric surgery workforce and surgical load in Brazil

Objective The purpose of this study is to examine the regional distribution of the pediatric surgery workforce and the expected local demand for pediatric surgical procedures in Brazil.Methods We collected data on the pediatric surgical workforce,surgical volume,Gross Domestic Product per capita,and mortality for gastrointestinal tract malformations(MGITM)across the different regions of Brazil for 2019.Results Data from the Federal Medical Council reported 1515 pediatric surgery registries in Brazil,corresponding to 1414 pediatric surgeons(some pediatric surgeons are registered in more than one state),or 2.4 pediatric surgeons per 100000 children 14 years of age and younger.There were 828 men and 586 women.The mean age was 51.5±12.8 years,and the mean time from graduation was 3.4±5.7 years.There is a higher concentration of pediatric surgeons in the wealthier Central-West,South,and Southeast regions.Individual surgical volume ranged from 88 to 245 operations/year(average 146 operations/year)depending on the region.Of these,only nine(6.1%)were high-complexity(including neonatal)operations.MGITM tended to be higher in the poorer North and Northeast regions than in other regions of Brazil.Conclusions Our findings suggest significant disparities in the surgical workforce and workload across Brazil related to socioeconomic status.Regions with an increased surgical workforce were associated with lower MGITM.The average number of complex operations performed annually by each pediatric surgeon was considerably low.Strategic investment and well-defined health policies are imperative to enhance the quality of surgical care in the different regions of Brazil.

Predictors of surgical complications in boys with hypospadias:data from an international registry

Background Complications are frequently reported after hypospadias repair and there is a need to understand the factors that influence their occurrence.Methods Data from boys with hypospadias born between 2000 and 2020 were obtained from the International Disorders of Sex Development(l-DSD)Registry.Logistic regressions,fisher's exact tests and spearman's correlation tests were performed on the data to assess associations between clinical factors and complication rates.Results Of the 551 eligible boys,data were available on 160(29%).Within the cohort,the median(range)External Masculinization Score(EMS)was 6(2,9).All presented with one or more additional genital malformation and 61(38%)presented with additional extragenital malformations.Disorders of androgen action,androgen synthesis and gonadal development were diagnosed in 28(18%),22(14%)and 9(6%)boys,respectively.The remaining 101(62%)patients were diagnosedas having non-specific 46,XY Disorders of Sex Development.Eighty(50%)boys had evidence of abnormal biochemistry,and gene variants were identified in 42(26%).Median age at first hypospadias surgery was 2 years(0,9),and median length of follow-up was 5 years(0,17).Postsurgical complications were noted in 102(64%)boys.There were no significant associations with postsurgical complications.Conclusions Boys with proximal hypospadias in the I-DSD Registry have high rates of additional comorbidities and a high risk of postoperative complications.No clinical factors were significantly associated with complication rates.High complication rates with no observable cause suggest the involvement of other factors which need investigation.