Assessing the Burden of Adolescent Care in Paediatric Surgery in a Single Tertiary Institution in the Caribbean: An Age-Stratified Case-Mix Audit.

OBJECTIVE: Paediatric surgical services are defined by age-specific physiology, pathology and care requirements, yet adolescents frequently present with acquired conditions that overlap with adult general surgical practice. We aimed to quantify the adolescent contribution to a tertiary Caribbean paediatric surgical service and describe how congenital/developmental and acquired disease varied across age strata. METHODS: This prospective 12-month service evaluation included referral/admission-log episodes, operative episodes and new outpatient visits managed by the Department of Paediatric Surgery at the Eric Williams Medical Sciences Complex, Trinidad and Tobago, from April 2024 to March 2025. Patients were grouped as neonates, infants, toddlers/preschool children, school-age children and adolescents (12 to <16 years). Diagnoses were classified as congenital/developmental, acquired or mixed using a prespecified ICD-10-informed framework. The primary outcome was the adolescent share of operative activity. RESULTS: The primary cohort comprised 964 referral/admission-log episodes, 379 operative episodes and 661 new outpatient visits. Adolescents accounted for 23.7% of referral/admission-log episodes, 17.4% of operations and 11.5% of new visits. They contributed 25.7% of emergency referrals and 28.7% of emergency operations. Acquired disease accounted for 72.7% of adolescent operations, compared with 13.3% in neonates, while congenital/developmental disease fell from 80.0% to 24.2%. Scrotal exploration, appendicectomy and drainage of soft-tissue collections comprised 97.0% of adolescent emergency operations. CONCLUSIONS: Adolescents generated a substantial, acquired-disease-dominant emergency workload. The findings support review of diagnosis-specific shared-care pathways while preserving paediatric resources for neonatal, congenital, oncological and reconstructive surgery.