Transitioning Complex Pediatric Surgical Patients to Adult Care: Practical Considerations for the Rural Surgeon

As management of complex gastrointestinal diseases of childhood improves, there are an increasing number of children who are reaching adulthood with a significant abdominal surgical history and need for ongoing surgical care. The transition from pediatric to adult surgical care is nuanced for many reasons and fraught with opportunities for patients to be lost to follow-up. Several studies delineate the severe risk to patients that can ensue. This paper seeks to provide a review of the current literature surrounding transfer of care from the pediatric surgeon to the adult surgeon and provides actionable interventions to optimize success, specific to the rural environment. Some factors to be discussed are patient specific, including condition-specific patient/family education and a focused effort to gradually have the pediatric patient take ownership of their healthcare. Pediatric surgeon factors include early initiation of transition, education of adult colleagues on pediatric conditions, forming strong working relationships with adult surgeons, and participation in multidisciplinary clinics facilitating transition. Adult surgeon factors include a willingness to accept these patients and a desire to understand the unique factors that accompany caring for transitioning patients, as well as similarly participating in multidisciplinary clinics. System-based factors include ensuring that the support staff and financial resources are available to provide extra support to these patients throughout this time. Finally, the unique challenges of rurality as it relates to transitioning rural patients and the surgeons that care for them will be addressed. The end goal of this project is to open a multidisciplinary discussion regarding how each institution can best address the needs of their transitioning surgical patients.