Real-world paediatric inflammatory bowel disease surgery: International variation in care and practice.
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OBJECTIVE: Paediatric inflammatory bowel disease (IBD) surgery is delivered across heterogeneous settings, with limited paediatric-specific evidence guiding organisation of care, perioperative management, and operative strategy. We characterised contemporary international practice. METHODS: An international cross-sectional centre-level survey was conducted within the Paediatric IBD Surgery Network. A 28-item questionnaire addressing organisation of care, perioperative management, procedural volumes, and surgical practice was distributed electronically. Analyses were descriptive and performed per question. RESULTS: Twenty-six of 36 invited centres from 14 countries responded (72%). University or teaching hospitals represented 96% of centres, and paediatric surgeons accounted for 69% of respondents. Regular multidisciplinary team meetings were reported by 85%. Use of an enhanced recovery after surgery protocol, structured nutritional screening, and deferral of elective surgery for nutritional optimisation whenever feasible were reported by 50%, 54%, and 42% of centres, respectively. Medication withholding varied, from corticosteroids in 69% of centres to anti-tumour necrosis factor (anti-TNF) agents in 31% and individual newer biologic or small-molecule classes in 15-19%. Formal national centralisation was reported as recommended or mandatory by 42%. Median annual luminal Crohn's disease surgery volume per centre was two procedures (interquartile range [IQR] 1-5) in 2018, 2.5 (IQR 2-5) in 2022, and 2.5 (IQR 1-5) in 2024. Median annual ileal pouch-anal anastomosis volume in children with ulcerative colitis was 1 (IQR 0.1-3.5). CONCLUSIONS: Considerable variation was observed in perioperative optimisation and medication management, integration of medical and surgical therapy, centralisation, and operative strategy. These findings provide a baseline for international benchmarking, consensus development, and prospective collaborative research.