To the Editor We read with interest the article by Akhtar-Danesh et al titled “Factors Associated With Outcome and Costs After Pediatric Laparoscopic Cholecystectomy”¹ and the accompanying editorial by Kelley-Quon et al titled “Considering the Ability of General Surgeons to Add Value to Pediatric Surgery.”² As leaders of the American College of Surgeons Children Surgical Verification Quality Improvement Program (ACS CSV), we wished to point out that the ACS CSV sets forth standards for institutions providing care for children undergoing surgery but does not specifically advocate for regionalization.³ It is up to local institutional judgment to determine the most appropriate health care professionals for certain surgical procedures, including adolescent cholecystectomy. In terms of pediatric-certified surgical, anesthesia, and nursing personnel, the ACS CSV standards specifically apply to children younger than 5 years and patients with higher acuity (ie, American Society of Anesthesiologists score of 3 or greater). Therefore, each institution must determine by means of institutional credentialing and perioperative quality assurance which surgeons are most capable of providing optimal care for otherwise healthy preteens and adolescents undergoing cholecystectomy.

致编辑我们感兴趣地阅读了Akhtar-Danesh等人的文章“小儿腹腔镜胆囊切除术后与结果和费用相关的因素” ¹和Kelley-Quon等人的随笔社论“考虑普通外科医师的增值能力”。儿科手术。” ²作为美国外科医师学会儿童外科手术验证质量改善计划（ACS CSV）的负责人，我们希望指出，ACS CSV规定了为接受手术的儿童提供照料的机构的标准，但并未专门倡导区域化。³由当地机构决定是否为某些手术程序（包括青春期胆囊切除术）确定最合适的医疗保健专业人员。对于经儿科认证的外科，麻醉和护理人员，ACS CSV标准专门适用于5岁以下的儿童和具有更高敏锐度的患者（即，美国麻醉医师学会评分为3或更高）。因此，每个机构必须通过机构认证和围手术期质量保证的方式来确定哪些外科医生最有能力为进行胆囊切除术的健康青春期和青少年提供最佳护理。