title: Essential and non-essential paediatric surgery: implications for the future delivery of state health care in the UK.
abstract: BACKGROUND
  Delivery of health care in the UK faces enormous challenges with the Department of Health driving significant financial cost savings to ensure viability of public health services. We have analysed and modelled the concept of 'essential' and 'non-essential' paediatric surgery linked to the delivery of children's surgery in the NHS in England.
  
  
  METHODS
  Operation codes for surgical operations in newborns, children and adolescents were identified and Healthcare Resource Group tariffs-£Stg matched. Operations were designated as 'essential' or 'non-essential' based on the criteria-(1) life saving-neonatal surgery, emergency general surgery of childhood, cancer surgery; (2) debility if uncorrected; (3) aesthetics and (4) culture/attitude. Hospital Episode Statistics (HES) data were accessed and sampled for the total number of paediatric surgical operations-(age range 0-14 years) performed in NHS hospitals from 2009 to 2010. Annual costs (£) of both 'essential' and 'non-essential' operations were then calculated.
  
  
  RESULTS
  The commonest 'essential' operations performed in children and adolescents in the year 2009-2010 was appendicectomy at a cost of over £51 million pounds. Costs of performing a selection of 'non-essential' paediatric surgery operations were >£14 million pounds/year. The NHs funds for example almost 11,000 paediatric circumcisions annually at a cost of >£8 million pounds-50% are performed for non-therapeutic reasons.
  
  
  CONCLUSIONS
  Surgeons must engage and work actively with health care systems to ensure diminishing financial resources prioritise 'essential' operations for children. Commissioners must embrace evidence-based surgery. 'Essential' and 'non-essential' surgery has wide implications for the sustainability of the NHS and concepts herein developed can be applied to nations worldwide.
authors.affiliation: Division of Child Health, Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, University of Liverpool, Liverpool, UK.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Farrelly
authors.forename: Paul D
authors.initials: PD
authors.lastname: Losty
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D019317:Evidence-Based Medicine; D006297:Health Services Accessibility / Q000191:economics; D006301:Health Services Needs and Demand / Q000191:economics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010372:Pediatrics / Q000191:economics*; D013222:State Medicine / Q000191:economics*; D013514:Surgical Procedures, Operative / Q000191:economics*; D006113:United Kingdom