Definition and Overview
There are cases where children undergo surgical procedure mostly to treat or correct congenital conditions. Before the surgery, the surgical team schedules a consultation with the parents or legal guardians to explain the complexities and expected results of the procedures. After the surgery, another follow-up consultation will be required but this time, the goal would be to check if the procedure was a success as well as monitor the progress of recovery and the patient’s general health.
Who Should Undergo and Expected Results
All paediatric surgery patients are required to undergo at least one follow-up consultation after the surgery. In some cases, more consultations might be required depending on the progress of the patient’s recovery and other factors.
The expected results of this consultation are the following:
- To determine if the patient is on the way to complete recovery
- To provide post-operative care, such as removal of stitches and splints
- To determine if additional treatment or surgical procedures are required to completely treat the condition
- To determine the need for medication or therapy that will improve the patient’s health
- To determine the presence of infection, side effects and other complications stemming from the surgical procedure
- To monitor the progress of recovery, or in worst-case scenarios, the progress of complications.
How is the Procedure Performed?
Paediatric surgery follow-up consultations are very similar to primary care consultations. However, the patient and the parents or guardians must strictly observe the timelines provided by the doctor for consultation. This is to prevent the onset of possible risks and complications and to immediately determine complementary treatment or procedures to aid in the recovery and long-term management of the patient’s condition.
A paediatrician or a primary care physician can perform the follow-up consultation, with the patient and the parents or legal guardians present during the whole session.
The patient and his or her parents will be asked general questions about the period after the hospital discharge and before the follow-up consultation. Tell-tale signs of infection, such as swelling and fever, will be duly noted and prescribed with further treatment. A leukocytosis test and culture studies might also be ordered to confirm the presence of infection.
In the event that the symptoms experienced by the patient are inconclusive, the doctor can order a series of laboratory tests to make a diagnosis. The doctor will often require a complete blood count information, as well as coagulation panel and blood platelet count, to determine if the patient is suffering from an ongoing blood loss since the operation. In procedures that entail fluid shift or loss, electrolyte levels will need to be checked through laboratory tests.
Pain management can also be provided for the patient. Paediatric patients who have undergone minor procedures will be prescribed with oral analgesics, such as ibuprofen or acetaminophen. However, patients who went through major surgery will require intravenous analgesics, which can be controlled by the parent or nurse providing post-surgery care.
Other laboratory tests and diagnostic imaging procedures can also be ordered to monitor the progress of the patient’s recovery. This might include urinalysis, stool tests, x-ray, magnetic resonance imaging (or MRI), or CT scans. Diagnostic imaging procedures can help the doctor determine if the patient is healing well internally, or if there are internal complications that do not manifest symptoms. Imaging procedures can also be helpful to monitor the patient's progress after being operated on for traumatic injuries.
A clean bill of health will only be provided after the doctor is satisfied that the patient is on his or her way to a full recovery. Follow-up consultations can occur months, or even years, after the surgical procedure itself.
Follow-up consultations typically end with a prescription for additional medication or therapy, or care guidelines for both the patient and parents or caregivers to follow closely.
Possible Risks and Complications
The consultation and diagnostic tests performed during the follow-up are generally safe.
Not going for a follow-up consultation after minor or major surgical procedures can pose a health risk to the patient. All surgical procedures come with possible risks and complications and post-operative follow-up consultations can prevent these from occurring.
Chung DH. Pediatric surgery. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 13.
Neumayer L, Vargo D. Principles of preoperative and operative surgery. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 11.