The pediatric population represents a consequential portion of clinical anesthesia care. It has become axiomatic that safe anesthesia care for children is more assured if provided by an anesthesiologist with pediatric anesthesiology fellowship training. However, both this educational approach and this patient care approach are being challenged by changes in the availability of pediatric surgery.

In this issue of Anesthesiology, McManus and Franca provide data that characterize the current consolidation trend in pediatric surgical care. They report that nationally, nonambulatory pediatric surgery takes place in a limited group of large specialized referral centers. Of hospitals admitting children, 9% conducted 90% of all pediatric surgical cases. Half of the hospitals reported fewer than 15 pediatric procedures per year, and three quarters reported fewer than 60 such procedures, of which “the vast majority were appendectomies, fracture...

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