Abstract
The NHS provides more than 98% of all surgical procedures in infants and children
in the United Kingdom through a comprehensive network of secondary (typically for
the general surgery of childhood) and tertiary (specialist neonatal and specialist
pediatric surgery) centers [n = 22]), typically located within large conurbations. It was originally envisaged
that these specialized centers would be able to provide the full range of surgical
interventions (aside from organ transplantation). However, there has been a trend
toward centralization of some key procedures, previously thought to be within general
neonatal surgery.
The architype for centralization is the management of biliary atresia (BA). Since
1999, within England and Wales, this has been exclusively managed in three centers
(King's College Hospital, London; Birmingham Children's Hospital and Leeds General
Infirmary). All of these provide facilities for the diagnosis of BA, primary surgical
management (Kasai portoenterostomy), and liver transplantation if required. The case
for centralization was made by rigorous national outcome analysis during the 1990s
showing marked disparity based on case volume and driven by parents' organizations
and national media. Following centralization, national outcome data showed improvement
and provided a benchmark for others to follow.
The management of bladder exstrophy was later centralized in England and Wales, albeit
not based on strict outcome data, to two centers (Great Ormond Street, London and
Royal Manchester Children's Hospital).
Keywords
centralization - surgery - NHS - biliary atresia - bladder exstrophy
