Finnish Pediatric Surgery Hub - From Centralization to Collective Learning and Sharing of Expertise

Infographic · Dec 2024 · 1 min read

In brief

Finland's nationwide pediatric surgery hub (FPSH) enabled five university hospitals to share surgical expertise through cooperative case management. Analysis of 40 surgeries (2021-2023) showed 30% complication rate with no severe adverse events, demonstrating that decentralized care with collaborative support maintains surgical safety while improving access to specialized pediatric surgical care.

Finland's 5 university hospitals created a collaborative hub (FPSH) enabling shared surgical expertise and decentralized neonatal surgery with collective decision-making.
75% of 40 cooperative cases were performed locally rather than centralized, with 30% complication rate (all ≤grade IIIB) and no association between location and outcomes.
Urgent cases were operated within median 1 day, demonstrating rapid coordination for time-sensitive neonatal conditions across distributed centers.
Model enabled standardized protocols and research collaboration beyond case-sharing, supporting continuous quality improvement across the national network.
Early safety data suggests decentralized expert-supported surgery is feasible for complex neonatal conditions like ARM, EA, and Hirschsprung disease.

Written by the GCMD Library team from the infographic.

A three-column comparison layout with illustrated diagrams of surgical procedures. Each column contains anatomical drawings in blue and pink tones showing the esophagus and stomach, accompanied by bullet-pointed text describing outcomes. The left column shows Heller myotomy, the middle shows esophageal dilatation, and the right shows POEM procedure. Success rates are prominently displayed with percentage figures.

Aim of the study: Continuous surgical developments, growing awareness of patient representatives and limited health-care resources are pushing for innovative approaches to ensure equal high-quality pediatric surgical care. We aimed to describe early experiences and assess surgical safety of a novel nationwide pediatric surgery collaborative initiative.

Methods: In 2021, general pediatric surgeons representing all five independent university hospitals performing neonatal surgery in Finland initiated national collaboration, the Finnish pediatric surgery hub (FPSH), for sharing of surgical expertise and collective learning. For each case addressed by FPSH, place of care and surgical team were decided individually, and when deemed necessary, operations were performed in cooperation. Operations performed during 2021-2023 and associated early (<30 days) postoperative complications were analyzed according to Clavien-Madadi classification.

Results: Of the total 40 surgeries managed co-operatively by FPSH, 30 (75%) took place in local university hospitals and 10 in Helsinki University Hospital. There were 34 (85%) elective and 6 urgent cases, which were operated within median 1 (range, 1-3) days. Most frequent underlying diagnoses included anorectal malformations, esophageal atresia and Hirschsprung disease. Overall, 12 (30%) had any early postoperative complications, all Clavien-Madadi grade IIIB or lower, and five patients (13%) were reoperated. Rate or grade of complications was not associated with place of care. In addition to regular virtual case meetings, national care protocols and research projects were introduced.

Conclusion: These preliminary findings suggest that our national collaborative initiative, FPSH, not only provided practical and safe framework for sharing of surgical expertise but also for collective learning.

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