Pediatric Surgeons' Expectations of the EUPSA Global Surgery Committee Across World Bank Income Groups: A Two-Round Modified Delphi Study.

AIM: The European Pediatric Surgeons' Association (EUPSA) recently established a Global Surgery Committee to promote equitable access to pediatric surgical care through international collaboration and capacity building. This study aimed to explore and prioritize pediatric surgeons' expectations regarding the role and activities of the EUPSA Global Surgery Committee across different World Bank income groups, with particular attention to perspectives from low- and middle-income settings. METHODS: A two-round modified Delphi study was conducted using online surveys distributed via EUPSA networks, pediatric surgical societies, and professional social media. In Round 1, participants provided up to five free-text expectations; responses underwent inductive thematic analysis. In Round 2, participants ranked six themes, rated 20 subthemes on a 1-10 Likert scale and selected three top priorities. Countries were classified using the 2025 World Bank income groups, and descriptive statistics were used for analysis. RESULTS: A total of 230 participants from 68 countries completed Round 1; 113 (49%) practiced in low- or lower-middle-income settings, 165 (72%) were consultant pediatric surgeons, and 196 (85%) worked in urban environments. Thematic analysis of 218 valid free-text responses identified six themes spanning guidelines, training, research, advocacy, infrastructure, and cross-cutting support. In Round 2, 65 complete responses were analyzed. Training-related support ranked highest across all income groups, followed by guidelines and knowledge resources and by infrastructure and service delivery. Fellowships or observerships and structured mentorship were consistently among the highest-rated subthemes. High-income respondents more often prioritized guidelines and registry or multicenter research support, whereas low- and lower-middle-income respondents placed greater emphasis on equipment, infrastructure, and advocacy. CONCLUSIONS: Pediatric surgeons across income settings perceive EUPSA's global surgery role as multidimensional, with a consistent prioritization of capacity building through training, mentorship, guidelines, and systems-oriented support.