Publication
Surgical interventions for children receiving palliative care: organizational, clinical, and ethical aspects
Ampar F, Afukov I, Vaganov N, Eremin D, Pikin O, Rozinov V · RJPSAR · 2026
BACKGROUND: A current trend in Russian pediatrics is an increase in the number of inpatient palliative care units for children and, accordingly, the number of beds and patients in this population. AIM: To identify the need for various types, forms, and techniques of surgical interventions depending on the pathology that indicates palliative care, clinical manifestations, risks of underlying disease complications, and planned procedures. METHODS: This retrospective observational study included data from 240 children with palliative status who underwent 405 different procedures between 2021 and 2025 at the G.N. Speransky Children's City Clinical Hospital No. 9. Older patients predominated (30.8%); no gender differences were found. The main group consisted of patients with cerebral palsy (40.4%), chronic (recurrent) respiratory failure (22.5%), and brain lesions (21.3%) of various etiologies. The assessment protocol included clinical, imaging, endoscopic, and laboratory methods. RESULTS: The most common procedures were gastrostomy (56.4%), tracheostomy (17.2%), thoracentesis with pleural drainage (10.3%), and fundoplication (9.1%). The number of procedures increased from 33 to 127 annually over the study period. We identified procedures aimed at improving quality of life and care conditions (75.8%), relieving (15.1%), and preventing (9.1%) complications. Elective surgery was performed in 66.9% of patients, while urgent and emergency procedures accounted for 17.5% and 15.6% of cases, respectively. Among early complications, wound suppuration predominated (1.7%); late complications included "bumper" syndrome and gastrostomy anchor failure in 3 (1.3%) patients. No procedure-related deaths occurred. CONCLUSION: Comprehensive palliative care for children was successfully implemented in a multidisciplinary children's hospital, where the surgical component is focused on preventing or alleviating suffering, improving quality of life for the child, family comfort, and working conditions for medical staff. With interdisciplinary agreement among specialists and a constructive approach from the patient's family, surgical interventions effectively and safely improve the quality of life of terminally ill children, alleviate suffering, and improve working conditions for medical staff.
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