title: Passing the baton: The pediatric surgical perspective on transition.
abstract: OBJECTIVE
  Transition of care from pediatric to adult providers is garnering intense national interest in pediatrics but is largely driven by nonsurgeons. We sought to describe the preferences of pediatric surgeons and their current transition practice patterns for various populations and wondered whether gender, experience, or practice setting affected surgeons' perspectives.
  
  
  METHODS
  All American Pediatric Surgical Association (APSA) members were surveyed electronically. Responses were voluntary and confidential.
  
  
  RESULTS
  Survey response rate was 22%. Most surgeons (95%) treated patients up to 22 years of age, and many cared for older patients (23-26 years, 49%; 27-30 years, 25%; 31-40 years, 18%; >40 years, 13%). Developmentally delayed adults comprised a significant portion of this population (54%). Congenital conditions such as Hirschsprung disease (25%), anorectal malformations (22%) and cystic fibrosis (22%) were most commonly reported. About half (52%) of respondents reported institutional limits for age. Lack of qualified adult surgeons was felt to be the greatest barrier to transition (p<0.001). Experience, gender and practice type did not significantly affect opinions of transition.
  
  
  CONCLUSIONS
  Pediatric surgeons care for adult patients with a variety of surgical conditions, particularly those with developmental delay and congenital anomalies. The perception of a deficit of qualified adult providers warrants further exploration. Understanding the barriers to surgical transition represents a critical step in improving the quality and appropriateness of care transitions.
authors.affiliation: Pediatric Surgery, Helen DeVos Children's Hospital, Grand Rapids, MI, United States. Electronic address: Emily.Durkin@helendevoschildrens.org.
authors.forename: Emily T
authors.initials: ET
authors.lastname: Durkin
authors.affiliation: Anesthesia and Biostatistics, Boston Children's Hospital, Boston, MA, United States.
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.affiliation: Pediatric Surgery, Boston Children's Hospital, Boston, MA, United States.
authors.forename: Shawn J
authors.initials: SJ
authors.lastname: Rangel
authors.affiliation: Pediatric Surgery, Boston Children's Hospital, Boston, MA, United States.
authors.forename: Craig W
authors.initials: CW
authors.lastname: Lillehei
authors.affiliation: Pediatric Gastroenterology, Boston Children's Hospital, Boston, MA, United States.
authors.forename: Laurie N
authors.initials: LN
authors.lastname: Fishman
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001003:Anal Canal / Q000002:abnormalities; D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000453:epidemiology; D002648:Child; D003550:Cystic Fibrosis / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006627:Hirschsprung Disease / Q000453:epidemiology; D006801:Humans; D008297:Male; D010372:Pediatrics / Q000706:statistics & numerical data*; D012007:Rectum / Q000002:abnormalities; D066231:Surgeons / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D060305:Transition to Adult Care / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Adolescent surgery; Barriers to transition; Pediatric surgical outcomes; Transition