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Ryan ML, Cairo SB, Williams RF. Response to the letter to the editor for our article entitled "Utility of Continuous Pulse Co-Oximetry for Hemoglobin Monitoring in Pediatric Patients with Solid Organ Injuries at Level 1 Trauma Centers: A Pilot Study". J Trauma Acute Care Surg 2024:01586154-990000000-00621. [PMID: 38229220 DOI: 10.1097/ta.0000000000004265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Affiliation(s)
- Mark L Ryan
- Division of Pediatric Surgery, Department of Surgery, Children's Medical Center Dallas/University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sarah B Cairo
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | - Regan F Williams
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
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Ryan ML, Cairo SB, McLaughlin C, Herring L, Williams RF. Utility of continuous pulse CO-oximetry for hemoglobin monitoring in pediatric patients with solid organ injuries at level 1 trauma centers: A pilot study. J Trauma Acute Care Surg 2023; 95:300-306. [PMID: 37158807 DOI: 10.1097/ta.0000000000003926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
INTRODUCTION Hemorrhage is a major cause of preventable death in injured children. Monitoring after admission often requires multiple blood draws, which have been shown to be stressful in pediatric patients. The Rainbow-7 device is a continuous pulse CO-oximeter that measures multiple wavelengths of light, permitting continuous estimation of the total hemoglobin (Hb) level. The purpose of this study was to evaluate the utility of the noninvasive Hb measurement for monitoring pediatric trauma patients admitted with solid organ injury. METHODS This is a prospective, dual-center, observational trial for patients younger than age 18 years admitted to a Level I pediatric trauma center. Following admission, blood was routinely measured as per current solid organ injury protocols. Noninvasive Hb monitoring was initiated after admission. Time-synced data for Hb levels were compared with that taken using blood draws. Data were evaluated using bivariate correlation, linear regression, and Bland-Altman analysis. RESULTS Over a 1-year period, 39 patients were enrolled. The mean ± SD age was 11 ± 3.8 years. Forty-six percent (n = 18) of patients were male. The mean ± SD Injury Severity Score was 19 ± 13. The average change in Hb levels between laboratory measurements was -0.34 ± 0.95 g/dL, and the average change in noninvasive Hb was -0.12 ± 1.0 g/dL per measurement. Noninvasive Hb values were significantly correlated with laboratory measurements ( p < 0.001). Trends in laboratory Hb measurements were highly correlated with changes in noninvasive levels ( p < 0.001). Bland-Altman analysis demonstrated similar deviation from the mean throughout the range of Hb values, but the differences between measurements were increased by anemia, African American race, and elevated shock index, pediatric age-adjusted score and Injury Severity Score. CONCLUSION Noninvasive Hb values demonstrated correlation with measured Hb concentration as isolated measurements and trends, although results were affected by skin pigmentation, shock, and injury severity. Given the rapid availability of results and the lack of requirement of venipuncture, noninvasive Hb monitoring may be a valuable adjunct for pediatric solid organ injury protocols. Further study is required to determine its role in management. LEVEL OF EVIDENCE Dianostic Test or Criteria; Level III.
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Affiliation(s)
- Mark L Ryan
- From the Division of Pediatric Surgery, Department of Surgery (M.L.R., S.B.C.), Children's Medical Center Dallas, University of Texas Southwestern Medical Center, Dallas, Texas; and Division of Pediatric Surgery, Department of Surgery (C.M., L.H., R.F.W.), Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee
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Coco CT, Batie SF, Cairo SB, Morris WZ, Pandya S, Passoni NM, Stewart RD, Peters CA, Jacobs MA. Delayed Surgical Management of an Unusual Classic Bladder Exstrophy Variant. Urology 2023; 172:178-181. [PMID: 36436675 DOI: 10.1016/j.urology.2022.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/18/2022] [Accepted: 09/25/2022] [Indexed: 11/26/2022]
Abstract
Anterior abdominal wall defects are rare anomalies that can affect multiple organ systems including gastrointestinal, genitourinary, musculoskeletal, and the neurospinal axis. The highly varied, complex anatomy in this patient population creates a challenging reconstruction scenario that merits careful surgical planning. We present an unusual female variant with an anorectal malformation as well as musculoskeletal and genital abnormalities consistent with classic bladder exstrophy in which the urinary bladder, sphincter, and urethra were largely uninvolved.
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Affiliation(s)
- Caitlin T Coco
- University of Texas Southwestern Medical Center, Children's Health in Dallas, Dallas, TX.
| | - Shane F Batie
- University of Texas Southwestern Medical Center, Children's Health in Dallas, Dallas, TX
| | - Sarah B Cairo
- University of Texas Southwestern Medical Center, Children's Health in Dallas, Dallas, TX
| | - William Z Morris
- University of Texas Southwestern Medical Center, Children's Health in Dallas, Dallas, TX
| | - Samir Pandya
- University of Texas Southwestern Medical Center, Children's Health in Dallas, Dallas, TX
| | | | - Robert D Stewart
- University of Texas Southwestern Medical Center, Children's Health in Dallas, Dallas, TX
| | - Craig A Peters
- University of Texas Southwestern Medical Center, Children's Health in Dallas, Dallas, TX
| | - Micah A Jacobs
- University of Texas Southwestern Medical Center, Children's Health in Dallas, Dallas, TX
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Cairo SB, Urias AR, Murphy JT. Pediatric Abdominal Malignancies and Intravascular Extension: Contemporary Single-Center Experience. J Surg Res 2022; 280:396-403. [PMID: 36037617 DOI: 10.1016/j.jss.2022.06.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/19/2022] [Accepted: 06/09/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Inferior vena cava (IVC) thrombus is an uncommon and challenging complication of abdominal malignancies in the pediatric population, which significantly influences the treatment options and clinical outcomes in this population. METHODS In this review, we present the presentation, treatments, interventions, and outcomes with this clinically and technically challenging oncological finding from a free-standing children's hospital from 2006 to 2017. RESULTS Fourteen patients with IVC thrombus were identified as having an associated abdominal malignancy. The abdominal malignancies consisted of eight Wilms tumors (63% stage III and 37% stage IV), and one spindle cell sarcoma, neuroblastoma (stage III), kidney clear cell sarcoma (stage III), sclerosing epithelioid fibrosarcoma, hepatoblastoma-epithelial (stage IV), and hepatic embryonal sarcoma (stage IV). 50% of patients were male, 71% White, 29% Black, 7% Hispanic; mean age at diagnosis was 4.09 (SD 2.43) years. CT imaging identified IVC tumor thrombus for 79% of patients, US abdomen complete recorded 14%, and MRI lumbar 7%. 3Out of 14 patients, 13 patients were taken to the operating room with 12 patients undergoing concurrent tumor resection and IVC thrombectomy. Of the remaining patients, one had IVC thrombectomy via femoral cutdown by interventional radiology, and one was noted to have resolution of IVC thrombus with neoadjuvant chemotherapy. Of patients who underwent resection, one required IVC ligation, and one patient required IVC interposition vein graft reconstruction using a right IJ conduit. 60% of patients undergoing thrombectomy received neoadjuvant chemotherapy. Mean time from the diagnosis of IVC tumor thrombus to surgical thrombectomy was 46 (SD 44) days. No operative mortalities were reported. There were five major complications (hemothorax, pulmonary embolisms, seroma, and sepsis) and two minor complications (pneumonia and UTI). With exclusion of patient who underwent IVC ligation, no patients developed signs of IVC compression or recurrent thrombosis after thrombectomy. CONCLUSIONS IVC tumor thrombus can significantly alter the clinical treatment, surgical options, and outcomes of malignant abdominal tumors. Treatment of IVC tumor thrombus included adjuvant chemotherapy, segmental IVC resection with or without reconstruction, thrombectomy with intimal stripping, or resection of the thrombus with part of the IVC wall. Evidence for standard treatment practices for IVC tumor thrombus in the setting of abdominal malignancy is lacking due to the rarity of this finding and the varied clinical presentations.
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Affiliation(s)
- Sarah B Cairo
- University of Texas Southwestern, Department of Pediatric Surgery, Dallas, Texas.
| | | | - Joseph T Murphy
- University of Texas Southwestern, Department of Pediatric Surgery, Dallas, Texas
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Jacobson JC, Clark RA, Cairo SB, Murphy JT, Chung DH. Multimodality treatment of pediatric Ewing sarcoma: A single-center 10-year analysis of outcomes. Surgery 2022; 172:1251-1256. [PMID: 35933175 DOI: 10.1016/j.surg.2022.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/10/2022] [Accepted: 05/30/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Ewing sarcoma, a malignancy originating from the bone or soft tissues most commonly diagnosed in adolescents, requires multimodality therapy. Although both surgical resection and radiation therapy are effective local control modalities, there are limited data comparing outcomes in patients treated with surgery versus radiation. We sought to determine whether there were differences in 5-year local failure-free survival, event-free survival, and overall survival based on the modality used for local control. METHODS Patients treated for Ewing sarcoma at a single tertiary pediatric hospital between 2010 and 2020 were included for retrospective analysis. Patient and tumor demographics, treatment information, and patient response to therapies were collected from the medical record. Outcome measures were local failure-free survival, event-free survival, and overall survival at 5 years from diagnosis. RESULTS Sixty-one patients met inclusion criteria. All patients received chemotherapy, and 68.9% of patients presented with localized disease. Of these, 23.8% were treated with radiation alone; the remaining 76.2% underwent resection ± radiation. A total of 52.4% of patients with localized disease achieved R0 resection. Only 3 patients experienced local progression; there was no difference between treatment groups. There was no significant association between local control modality and event-free survival or overall survival in patients with localized disease, regardless of margin status. CONCLUSION There was no significant difference in 5-year local failure-free survival, event-free survival, or overall survival in Ewing sarcoma patients treated with radiation versus surgery ± radiation, regardless of whether or not R0 resection was achieved. Future directions include a multi-institutional study to allow for further subgroup analysis and increased sample size.
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Affiliation(s)
- Jillian C Jacobson
- Department of Pediatric Surgery, University of Texas Southwestern Medical Center and Children's Health, Dallas, TX
| | - Rachael A Clark
- Department of Pediatric Surgery, University of Texas Southwestern Medical Center and Children's Health, Dallas, TX
| | - Sarah B Cairo
- Department of Pediatric Surgery, University of Texas Southwestern Medical Center and Children's Health, Dallas, TX
| | - Joseph T Murphy
- Department of Pediatric Surgery, University of Texas Southwestern Medical Center and Children's Health, Dallas, TX
| | - Dai H Chung
- Department of Pediatric Surgery, University of Texas Southwestern Medical Center and Children's Health, Dallas, TX.
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Cairo SB, Pu Q, Malemo Kalisya L, Fadhili Bake J, Zaidi R, Poenaru D, Rothstein DH. Geospatial Mapping of Pediatric Surgical Capacity in North Kivu, Democratic Republic of Congo. World J Surg 2021; 44:3620-3628. [PMID: 32651605 DOI: 10.1007/s00268-020-05680-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Despite recent attention to the provision of healthcare in low- and middle-income countries, improvements in access to surgical services have been disproportionately lagging. METHODS This study analyzes the geographic variability in access to pediatric surgical services in the province of North Kivu, Democratic Republic of Congo (DRC). On-site data collection was conducted using the Global Assessment of Pediatric Surgery tool. Spatial distribution of providers was mapped using the Geographical Information System and open-sourced spatial data to determine distances traveled to access surgical care. RESULTS Forty facilities were evaluated across 32 health zones; 68.9% of the provincial population was within 15 km of these facilities. Eleven facilities met a minimum World Health Organization safety score of 8; 48.1% of the population was within 15 km of corresponding facilities. The majority of children were treated by someone with specific pediatric surgery training in only 4 facilities; one facility had a trained pediatric anesthesia provider. Fifty-seven percent of the population was within 15 km of a facility with critical care and emergency medicine (EM) capabilities. There was one pediatric critical care provider and no pediatric EM providers identified within the province. Location-allocation assessment is needed to combine geographic area with potential for greatest impact and facility assessment. CONCLUSIONS Limitations in access to surgical care in the DRC are multifactorial with poor resources, few formally trained surgical providers, and near-absent access to pediatric anesthesiologists. The study highlights the deficits in the capacity for surgical care while demonstrating a reproducible model for assessment and identification of ways to improve access to care.
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Affiliation(s)
- Sarah B Cairo
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, 1001 Main Street, Buffalo, NY, 14203, USA. .,Department of Surgery, Maine Medical Center, Portland, ME, USA.
| | - Qiang Pu
- Department of Geography, University At Buffalo, The State University of New York, Buffalo, NY, USA
| | - Luc Malemo Kalisya
- HEAL Africa Hospital, COSECSA Training Program, Goma, North Kivu Province, Democratic Republic of Congo
| | - Jacques Fadhili Bake
- HEAL Africa Hospital, COSECSA Training Program, Goma, North Kivu Province, Democratic Republic of Congo
| | - Rene Zaidi
- HEAL Africa Hospital, COSECSA Training Program, Goma, North Kivu Province, Democratic Republic of Congo
| | - Dan Poenaru
- Department of Pediatric Surgery, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
| | - David H Rothstein
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, 1001 Main Street, Buffalo, NY, 14203, USA.,Department of Surgery, University At Buffalo, The State University of New York, Buffalo, NY, USA
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Kalisya LM, Bake JF, Elisee B, Nyavandu K, Perry R, Rothstein DH, Cairo SB. Surgical Repair of Orofacial Clefts in North Kivu Province of Eastern Democratic Republic of Congo (DRC). Cleft Palate Craniofac J 2020; 57:1314-1319. [PMID: 32787585 DOI: 10.1177/1055665620947604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND There is a high prevalence of orofacial clefts in low- and middle-income countries with significant unmet need, despite having 50% of the population younger than 18 years in countries such as the Democratic Republic of Congo (DRC). The purpose of this article is to report on the experience of general surgeons with orofacial clefts at a single institution. METHODS This is a retrospective study of patients treated for cleft lip/palate in the province of North Kivu, DRC between 2008 and 2017. RESULTS A total of 1112 procedures (122/year) were performed. All procedures were performed by general surgeons following training by an international nongovernmental aid organization. A total of 59.2% of patients were male and the median age was 3.4 years (interquartile range: 0.7-13 years). Average distance from surgical center to patient location was 242.6 km (range: 2-1375 km) with outreach performed for distances >200 kms. A majority (82.1%) of patients received general anesthesia (GA) with significant differences in use of GA, age, weight, and length of stay by major orofacial cleft category. Of the 1112 patients, 86.1% were reported to have cleft lip alone, 10.5% had cleft lip and palate, and 3.4% cleft palate alone. Despite this, only 5.3% of patients underwent surgical repair of cleft palate. CONCLUSIONS Multiple factors including malnutrition, risk of bleeding, procedural complexity, and cosmetic results may contribute to the distribution of procedures performed where most cleft palates are not treated. Based on previously published estimates, unmet needs and social burden of cleft lip and palate are high in the DRC.
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Affiliation(s)
| | | | - Bake Elisee
- HEAL Africa Hospital, COSECSA Training Program, Buffalo, NY, USA
| | - Kavira Nyavandu
- HEAL Africa Hospital, COSECSA Training Program, Buffalo, NY, USA
| | - Robert Perry
- Department of Surgery, State University of New York at Buffalo, Buffalo, NY, USA.,Division of Pediatric Plastic Surgery, 23561John R. Oishei Children's Hospital, Buffalo, NY, USA
| | - David H Rothstein
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, NY, USA.,Department of Surgery, State University of New York at Buffalo, Buffalo, NY, USA
| | - Sarah B Cairo
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, NY, USA
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Zhao J, Cairo SB, Tian Y, Lautz TB, Berkelhamer SK, Pizzuto MP, Raval MV, Rothstein DH. Gastrostomy tube placement in neonates undergoing tracheostomy: an opportunity to coordinate care? J Perinatol 2020; 40:1228-1235. [PMID: 32483142 DOI: 10.1038/s41372-020-0699-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/29/2020] [Accepted: 05/19/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To describe variations in timing of gastrostomy tube (GT) placement for neonates undergoing tracheostomy. METHODS Database study of neonates undergoing tracheostomy and GT placement using the Pediatric Health Information System (2012-2015). The primary outcome was timing of GT relative to tracheostomy. Logistic regression evaluated associations of patient- and hospital-level characteristics with GT timing. RESULTS Of 1156 patients undergoing GT and tracheostomy placement, 42.4% had concurrent GT placement, 23.3% GT placement prior to tracheostomy, and 34.3% GT placement after tracheostomy. The proportion of patients undergoing concurrent placement ranged from 0 to 80% among 47 hospitals. Neonates born at 31-35 weeks, having cardiovascular comorbidities, history of diaphragmatic hernia repair, or gastroesophageal reflux disorder were more likely to receive GT placement prior to tracheostomy. CONCLUSION Significant variability exists in the timing of neonatal tracheostomy and GT placement. Opportunities may exist to optimize coordination of care for neonates and reduce anesthetic exposure and hospital resource utilization.
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Affiliation(s)
- Jane Zhao
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, NY, USA
| | - Sarah B Cairo
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, NY, USA
| | - Yao Tian
- Division of Pediatric Surgery, Department of Surgery, Ann and Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Timothy B Lautz
- Division of Pediatric Surgery, Department of Surgery, Ann and Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sara K Berkelhamer
- Division of Neonatology, John R. Oishei Children's Hospital, Buffalo, NY, USA.,Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Michael P Pizzuto
- Division of Pediatric Otolaryngology, John R. Oishei Children's Hospital, Buffalo, NY, USA
| | - Mehul V Raval
- Division of Pediatric Surgery, Department of Surgery, Ann and Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David H Rothstein
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, NY, USA. .,Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA.
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Piper KN, Baxter KJ, Wetzel M, McCracken C, Travers C, Slater B, Cairo SB, Rothstein DH, Cina R, Dassinger M, Bonasso P, Lipskar A, Denning NL, Huang E, Shah SR, Cunningham ME, Gonzalez R, Kauffman JD, Heiss KF, Raval MV. Provider education decreases opioid prescribing after pediatric umbilical hernia repair. J Pediatr Surg 2020; 55:1319-1323. [PMID: 31109731 DOI: 10.1016/j.jpedsurg.2019.04.035] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/09/2019] [Accepted: 04/14/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To improve opioid stewardship for umbilical hernia repair in children. METHODS An educational intervention was conducted at 9 centers with 79 surgeons. The intervention highlighted the importance of opioid stewardship, demonstrated practice variation, provided prescribing guidelines, encouraged non-opioid analgesics, and encouraged limiting doses/strength if opioids were prescribed. Three to six months of pre-intervention and 3 months of post-intervention prescribing practices for umbilical hernia repair were compared. RESULTS A total of 343 patients were identified in the pre-intervention cohort and 346 in the post-intervention cohort. The percent of patients receiving opioids at discharge decreased from 75.8% pre-intervention to 44.6% (p < 0.001) post-intervention. After adjusting for age, sex, umbilicoplasty, and hospital site, the odds ratio for opioid prescribing in the post- versus the pre-intervention period was 0.27 (95% CI = 0.18-0.39, p < 0.001). Among patients receiving opioids, the number of doses prescribed decreased after the intervention (adjusted mean 14.3 to 10.4, p < 0.001). However, the morphine equivalents/kg/dose did not significantly decrease (adjusted mean 0.14 to 0.13, p = 0.20). There were no differences in returns to emergency departments or hospital readmissions between the pre- and post-intervention cohorts. CONCLUSIONS Opioid stewardship can be improved after pediatric umbilical hernia repair using a low-fidelity educational intervention. TYPE OF STUDY Retrospective cohort study. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Kaitlin N Piper
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Katherine J Baxter
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Martha Wetzel
- Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Courtney McCracken
- Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Curtis Travers
- Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Bethany Slater
- Department of Pediatric Surgery, The University of Chicago Medical Center, Chicago, IL, USA
| | - Sarah B Cairo
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, NY, USA
| | - David H Rothstein
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, NY, USA
| | - Robert Cina
- Division of Pediatric Surgery, Medical University Of South Carolina, Charleston, SC, USA
| | - Melvin Dassinger
- Department of Pediatric Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Patrick Bonasso
- Department of Pediatric Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Aaron Lipskar
- Division of Pediatric Surgery, Department Of Surgery, Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Naomi-Liza Denning
- Division of Pediatric Surgery, Department Of Surgery, Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Eunice Huang
- Division of Pediatric Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, TN, USA
| | - Sohail R Shah
- Division of Pediatric Surgery, Baylor College of Medicine, TX, USA
| | | | - Raquel Gonzalez
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, MD, USA
| | - Jeremy D Kauffman
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, MD, USA
| | - Kurt F Heiss
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Mehul V Raval
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
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Cairo SB, Burk JK, Rothstein DH. Pediatric hospitalizations and in-patient mortality from all-terrain vehicle crashes, 2006–2016. Trauma 2020. [DOI: 10.1177/1460408619830858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PurposeTo evaluate trends in national frequency of hospitalizations and in-patient mortality in the United States for children injured in all-terrain vehicle crashes during the past decade.MethodsRetrospective review of the 2006, 2009, 2012, and 2016 Kids' Inpatient Databases to identify hospitalizations of patients <19 years of age for all-terrain vehicle-related injuries. External-cause-of-injury codes were used to identify patients hospitalized for injuries sustained in all-terrain vehicle crashes. Odds ratios for in-patient mortality were calculated by logistic regression incorporating multiple individual demographic and hospital variables.ResultsEstimated all-terrain vehicle-related hospitalizations ranged from 3666 in 2006 (5.2/100,000 persons <19 years of age) to 2558 in 2012 (3.3/100,000). Crude in-patient mortality was low, and varied slightly from year to year (range, 0.55–1.04%). Patients hospitalized for all-terrain vehicle-related injuries were 76.8–78.4% White and 72.1–77.2% male. Totally 61.0–64.3% had private insurance, 35.3–39.3% were from rural areas, 37.4–38.3% were in the 10–14-year age group, and patients from the West region accounted for 40.4–43.6% of patients. There were no risk factors identified as being consistently associated with mortality in this cohort. Average total charges increased from $26,996 to $67,370 over the course of the study ( p < 0.001).ConclusionsHospitalizations for all-terrain vehicle-related injuries in children have fallen in the past decade although the reasons for this change are unknown. In-patient mortality rates have stayed relatively constant and while no factors were predictive of in-patient mortality, demographic data may provide an opportunity for targeted interventions to further reduce injuries and associated hospital costs.
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Affiliation(s)
- Sarah B Cairo
- Department of Pediatric Surgery, John R Oishei Children's Hospital, Buffalo, NY, USA
| | - Joshua K Burk
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - David H Rothstein
- Department of Pediatric Surgery, John R Oishei Children's Hospital, Buffalo, NY, USA
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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Rothstein DH, Cairo SB, Schaefer BA, Lautz TB. Association of perioperative red blood cell transfusion with postoperative venous thromboembolism in pediatric patients: A propensity score matched analysis. Pediatr Blood Cancer 2019; 66:e27919. [PMID: 31298495 DOI: 10.1002/pbc.27919] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To examine the association between perioperative red blood cell (RBC) transfusion and postoperative venous thromboembolism (VTE) in pediatric surgical patients. METHODS Retrospective cohort study using the National Surgical Quality Improvement Project Pediatric, a validated registry of 118 United States children's hospitals. Patients under 19 years of age undergoing a surgical procedure between 2012 and 2017 were included, with the main exposure being RBC transfusion in the perioperative period (48 hours prior to operation to 72 hours after operation). The primary 30-day outcome of interest was a postoperative VTE requiring therapy. Risk-adjusted odds ratios (aOR) were calculated using multiple logistic regression. Subgroup analyses were performed across multiple surgical specialties. Sensitivity analyses were performed after (a) imputation for missing variables and (b) propensity score matching. RESULTS During the study years, 482 867 pediatric patients (56.7% male; median age, 6 years [interquartile range, 1-12 years]) underwent an operation. Of these, 30 879 (6.4%) received at least one perioperative RBC transfusion. Postoperative VTE requiring therapy occurred in 618 patients (0.13%). After adjustment for multiple risk factors, perioperative RBC transfusion was associated with an increased risk of VTE (aOR 2.4; 95% CI, 1.9-3.0). The increased VTE risk persisted after imputation of missing demographic and clinical data as well as after 1:1 propensity score matching (29 811 matched pairs, aOR 2.2; 95% CI, 1.7-2.8). CONCLUSIONS Perioperative RBC transfusion is associated with an increased, albeit still very low, risk of postoperative VTE in pediatric patients. Patients receiving blood in the perioperative period may benefit from additional monitoring or VTE prophylaxis.
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Affiliation(s)
- David H Rothstein
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, New York.,Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Sarah B Cairo
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, New York
| | - Beverly A Schaefer
- Department of Pediatric Hematology and Oncology, John R. Oishei Children's Hospital, Buffalo, New York.,Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Timothy B Lautz
- Department of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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Cairo SB, Zeinali LI, Berkelhamer SK, Harmon CM, Rao SO, Rothstein DH. Down Syndrome and Postoperative Complications in Children Undergoing Intestinal Operations. J Pediatr Surg 2019; 54:1832-1837. [PMID: 30611525 DOI: 10.1016/j.jpedsurg.2018.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/24/2018] [Accepted: 11/09/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This paper intends to evaluate the association between Down Syndrome (DS) and postoperative medical and surgical complications and inpatient postoperative mortality in pediatric patients undergoing intestinal operations. METHODS The 2012 Kids' Inpatient Database was queried to compare short-term postoperative medical and surgical complications and in-patient mortality among patients with DS undergoing intestinal operations to a cohort without DS using inverse probability weighting. Subset analysis was performed for patients undergoing intestinal operations exclusive of gastrostomy placement. Adverse treatment effects were calculated for the outcomes of interest. RESULTS Of 17,026 pediatric patients undergoing intestinal operations, 444 had DS. In unadjusted analysis, medical complications (urinary tract infection, deep venous thrombosis, sepsis, pneumonia) occurred in 7.9% of patients with DS, compared to 14.1% of those without (p < 0.001). Surgical complications (wound disruption, hemorrhage, superficial or deep wound infection) occurred in 3.5% of patients with DS, compared to 4.6% of those without (p = 0.34), and in-patient mortality occurred in 0.3% of patients with DS, compared to 2.7% of those without (p = 0.009). Adverse treatment effects (ATE) calculated after inverse probability weighting demonstrated no difference for medical or surgical complications but a significantly decreased mortality with DS. CONCLUSIONS Contrary to common perception and data extrapolated from the adult literature, pediatric patients with DS have neither higher medical nor surgical complication rates after intestinal operations. Similar to patients undergoing congenital heart surgery, pediatric patients with DS have a lower postoperative inpatient mortality after these general operations compared to those without DS. Mechanisms influencing risks in DS patient remain unknown. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Sarah B Cairo
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, NY.
| | - Lida I Zeinali
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
| | - Sara K Berkelhamer
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Division of Neonatology, John R. Oishei Children's Hospital, Buffalo, NY
| | - Carroll M Harmon
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, NY; Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
| | - Sri O Rao
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Division of Pediatric Cardiology, John R. Oishei Children's Hospital, Buffalo, NY
| | - David H Rothstein
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, NY; Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
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Cairo SB, Zhao J, Ha M, Bass KD. Porcine bladder extracellular matrix in paediatric pilonidal wound care: healing and patient experience evaluation. J Wound Care 2019; 28:S12-S19. [PMID: 31067171 DOI: 10.12968/jowc.2019.28.sup5.s12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Pilonidal disease (PD) with inflammation and abscess formation occurs frequently in adolescents. The management of pilonidal disease, time to wound healing, and patient satisfaction, however remains variable despite advances in wound care methods. Porcine bladder extracellular matrix (PBEM) facilitates site-specific tissue deposition/re-growth for the management of a variety of wounds. The aim was to describe the use and outcomes of PBEM in PD at a single centre. METHOD A retrospective chart review of adolescent patients who underwent treatment of pilonidal disease with PBEM between 2012 and 2016 at a single institution, was undertaken. Patient demographics and clinical characteristics were collected and compared with historical controls and literature regarding traditional wound therapies. RESULTS We reviewed 52 pilonidal disease wounds on 41 patients. Of these 36 were treated with PBEM. The average age was 16 years old at the time of operation with 39% male. Furthermore, 85% were being treated for recurrent pilonidal disease. Follow-up was available by chart review for 89% of patients with documented complete wound healing in 78% of patients treated with PBEM at an average of two months. Subjective reports included majority positive experience with PBEM dressing, minimal pain and overall high levels of patient satisfaction. There were three patients in which pilonidal disease recurred within two years of initial treatment and underwent repeat treatment with PBEM. There was one patient who transitioned to wet-to-dry saline dressings because of difficulty keeping the PBEM dressing intact. CONCLUSION Advances in wound care technology include materials such as PBEM to promote site-specific tissue deposition. Follow-up phone calls and a prospective study to compare alternative wound care with porcine PBEM in the management of pilonidal disease is underway to better quantify time to wound healing and patient satisfaction.
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Affiliation(s)
- Sarah B Cairo
- Pediatric Surgery Research Fellow, John R. Oishei Children's Hospital, Department of Pediatric Surgery, 1001 Main Street, Buffalo, NY 14202, US
| | - Jane Zhao
- Bioinformatics Research Fellow, State University of New York, University at Buffalo, Department of Surgery, Buffalo, NY 14222, US
| | - Minje Ha
- Medical Student, State University of New York, University at Buffalo, Jacobs School of Biomedical Sciences, Buffalo, NY 14222, US. reference numbers
| | - Kathryn D Bass
- John R. Oishei Children's Hospital, Department of Pediatric Surgery, 1001 Main Street, Buffalo, NY 14202, US, State University of New York, University at Buffalo, Department of Surgery, Buffalo, NY 14222, US
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Cairo SB, Craig W, Gutheil C, Han PKJ, Hyrkas K, Macken L, Whiting JF. Quantitative Analysis of Surgical Residency Reform: Using Case-Logs to Evaluate Resident Experience. J Surg Educ 2019; 76:25-35. [PMID: 30195662 DOI: 10.1016/j.jsurg.2018.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 04/17/2018] [Accepted: 05/27/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Curricular changes at a mid-sized surgical training program were developed to rebalance clinical rotations, optimize education over service, decrease the size of service teams, and integrate apprenticeship-type experiences. This study quantifies the operative experience before and after implementation as part of a mixed-methods program evaluation. STUDY DESIGN Retrospective review of case-log data and data from the Accreditation Council for Graduate Medical Education (ACGME) and the American College of Surgeons National Surgical Quality Improvement Program: quality in-training initiative to evaluate case volume pre- and postintervention. RESULTS 11,365 cases, excluding "first-assistant" and "endoscopic" cases, were logged for an average of 291 and 263 cases/resident pre- and postintervention, respectively. Average case volume increased significantly for postgraduate year (PGY) 3 residents and decreased significantly for PGY 4 residents between the two time periods. Variability was observed among residents at the same PGY level both pre- and postintervention, with coefficients of variation of 6.0% to 34.1% in 2014 to 2015 and 11.2% to 66.8% in 2015 to 2016. Inter-resident variability persisted when comparing a specific procedure between ACGME case-log and quality in-training initiative data sets. CONCLUSION The data suggest that inter-resident variability in case load is not an artifact of case logging behavior alone, but may reflect personal preferences and choices in case selection that are not impacted by curriculum change. Logging behavior and accuracy of case-logs may contribute to variability. The shift in case load from PGY 4 to PGY 3 after curriculum implementation requires validation by ongoing analysis of ACGME case-log data.
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Affiliation(s)
- Sarah B Cairo
- Maine Medical Center Department of Surgery, Portland, Maine; Women and Children's Hospital of Buffalo, Buffalo, New York.
| | - Wendy Craig
- Center for Outcomes Research and Evaluation (CORE) and Maine Medical Center Research Institute, Portland, Maine
| | - Caitlin Gutheil
- Center for Outcomes Research and Evaluation (CORE) and Maine Medical Center Research Institute, Portland, Maine
| | - Paul K J Han
- Center for Outcomes Research and Evaluation (CORE) and Maine Medical Center Research Institute, Portland, Maine; Palliative Medicine, Hospice of Southern Maine, Scarborough, Maine
| | - Kristiina Hyrkas
- Center for Nursing Research and Quality Outcomes, Maine Medical Center, Portland, Maine
| | - Lynda Macken
- Center for Nursing Research and Quality Outcomes, Maine Medical Center, Portland, Maine
| | - James F Whiting
- Maine Medical Center Department of Surgery, Portland, Maine; Clinical Associate Professor of Surgery, Tufts University School of Medicine at Maine Medical Center, Portland, Maine
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Cairo SB, Arbuthnot M, Boomer LA, Dingeldein MW, Feliz A, Gadepalli S, Newton CR, Ricca R, Vogel AM, Rothstein DH. Controversies in extracorporeal membrane oxygenation (ECMO) utilization and congenital diaphragmatic hernia (CDH) repair using a Delphi approach: from the American Pediatric Surgical Association Critical Care Committee (APSA-CCC). Pediatr Surg Int 2018; 34:1163-1169. [PMID: 30132059 DOI: 10.1007/s00383-018-4337-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Review current practices and expert opinions on contraindications to extracorporeal membrane oxygenation (ECMO) in congenital diaphragmatic hernia (CDH) and contraindications to repair of CDH following initiation of ECMO. METHODS Modified Delphi method was employed to achieve consensus among members of the American Pediatric Surgical Association Critical Care Committee (APSA-CCC). RESULTS Overall response rate was 81% including current and former members of the APSA-CCC. An average of 5-15 CDH repairs were reported annually per institution; 26-50% of patients required ECMO. 100% of respondents would not offer ECMO to a patient with a complex or unrepairable cardiac defects or lethal chromosomal abnormality; 94.1% would not in the setting of severe intracranial hemorrhage (ICH). 76.5% and 72.2% of respondents would not offer CDH repair to patients on ECMO with grade III-IV ICH or new diagnosis of lethal genetic or metabolic abnormalities, respectively. There was significant variability in whether or not to repair CDH if unable to wean from ECMO at 4-5 weeks. CONCLUSIONS Significant variability in practice pattern and opinions exist regarding contraindications to ECMO and when to offer repair of CDH for patients on ECMO. Ongoing work to evaluate outcomes is needed to standardize management and minimize potentially futile interventions. LEVEL OF EVIDENCE V (expert opinion).
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Affiliation(s)
- Sarah B Cairo
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, 1001 Main Street, Buffalo, NY, 14203, USA.
| | - Mary Arbuthnot
- Department of Pediatric and General Surgery, Naval Medical Center Portsmouth, Portsmouth, USA
| | - Laura A Boomer
- Department of Surgery, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, USA
| | - Michael W Dingeldein
- Department of Pediatric Surgery, Rainbow Babies and Children Hospital, Cleveland, USA
| | - Alexander Feliz
- Department of Pediatric Surgery, University of Tennessee Health Sciences, Memphis, USA
| | - Samir Gadepalli
- C.S. Mott Children's Hospital, Michigan Medicine, Ann Arbor, USA
| | - Chris R Newton
- Department of Pediatric Surgery, University of California at San Francisco Benioff Children's Hospital Oakland, San Francisco, USA
| | - Robert Ricca
- Department of Pediatric and General Surgery, Naval Medical Center Portsmouth, Portsmouth, USA
| | - Adam M Vogel
- Department of Pediatric General Surgery, Texas Children's Hospital, Houston, USA
| | - David H Rothstein
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, 1001 Main Street, Buffalo, NY, 14203, USA.,Department of Surgery, Jacobs School of Medicine, State University of New York, University at Buffalo, Buffalo, USA
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Cairo SB, Tabak BD, Berman L, Berkelhamer SK, Yu G, Rothstein DH. Mortality after emergency abdominal operations in premature infants. J Pediatr Surg 2018; 53:2105-2111. [PMID: 29453133 DOI: 10.1016/j.jpedsurg.2018.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/19/2017] [Accepted: 01/15/2018] [Indexed: 01/03/2023]
Abstract
CONTEXT/BACKGROUND To determine risk of 30-day mortality for premature infants undergoing abdominal operations during the first 2 months of life and to identify risk factors for perioperative mortality using available demographic and clinical variables of interest. BASIC PROCEDURES Retrospective descriptive analysis of premature infants (gestational age less than or equal to 36weeks) undergoing abdominal operations during the first 2 months of life using the American College of Surgeon's National Surgical Quality Improvement Project Pediatric (NSQIP-P, 2012-2015) database. A stepwise logistic regression model incorporating multiple demographic and clinical factors was constructed to identify independent predictors of 30-day mortality. FINDINGS A total of 1554 premature infants were identified who underwent abdominal operations during the first 2 months of life. Unadjusted 30-day mortality ranged from 31% for infants born <24weeks gestational age to 4.9% for those born at 35-36weeks. Increased gestational age corresponded to decreased risk of mortality but week-by-week was not independently predictive of mortality in multivariate modeling. Female sex (aOR 1.51, 95% C.I. 1.08-2.10, p=0.014), inotrope support (aOR 3.46, 95% C.I. 2.43-4.92, p<0.001), ventilator use (aOR 2.86, 95% C.I. 1.56-5.25, p<0.001) and American Society of Anesthesiologists (ASA) class 3 (aOR 4.14, 95% C.I. 1.58-10.81, p=0.004) at time of operation were all associated with significantly increased risk of 30-day mortality. On stepwise logistic regression incorporating only those variables with statistical significance, female sex, inotrope, and ventilator support retained statistical significance. CONCLUSIONS Premature infants undergoing abdominal operations during the first 2 months of life have expectedly high risk of 30-day mortality. Female sex, inotrope, and ventilator support are independently associated with increased risk of mortality and can be incorporated into a model where, if present, risk of mortality is greater than 14.2%. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Sarah B Cairo
- Department of Surgery, John R. Oishei Children's Hospital, 1001 Main Street, Buffalo, NY 14202, USA.
| | - Benjamin D Tabak
- Tripler Army Medical Center, Department of Pediatric Surgery, 1 Jarrett White Rd, Honolulu, HI 96859, USA.
| | - Loren Berman
- Division of Pediatric Surgery, Nemours - Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, Delaware 19803.
| | - Sara K Berkelhamer
- Division of Neonatology, John R. Oishei Children's Hospital, 1001 Main Street, Buffalo, NY 14202, USA; State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences, 3435 Main Street, Buffalo, NY, USA.
| | - Guan Yu
- Department of Biostatistics, University at Buffalo School of Public Health and Health Professions, 710 Kimball Tower, Buffalo, NY 14214, USA.
| | - David H Rothstein
- State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences, 3435 Main Street, Buffalo, NY, USA; Department of Surgery, John R. Oishei Children's Hospital, 1001 Main Street, Buffalo, NY 14222, USA.
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Cairo SB, Lautz TB, Schaefer BA, Yu G, Naseem HUR, Rothstein DH. Risk factors for venous thromboembolic events in pediatric surgical patients: Defining indications for prophylaxis. J Pediatr Surg 2018; 53:1996-2002. [PMID: 29370891 DOI: 10.1016/j.jpedsurg.2017.12.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 11/24/2017] [Accepted: 12/14/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) in pediatric surgical patients is a rare event. The risk factors for VTE in pediatric general surgery patients undergoing abdominopelvic procedures are unknown. STUDY DESIGN The American College of Surgeon's National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database (2012-2015) was queried for patients with VTE after abdominopelvic general surgery procedures. Patient and operative variables were assessed to identify risk factors associated with VTE and develop a pediatric risk score. RESULTS From 2012-2015, 68 of 34,813 (0.20%) patients who underwent abdominopelvic general surgery procedures were diagnosed with VTE. On multivariate analysis, there was no increased risk of VTE based on concomitant malignancy, chemotherapy, inflammatory bowel disease, or laparoscopic surgical approach, while a higher rate of VTE was identified among female patients. The odds of experiencing VTE were increased on stepwise regression for patients older than 15 years and those with preexisting renal failure or a diagnosis of septic shock, patients with American Society of Anesthesia (ASA) classification ≥ 2, and for anesthesia time longer than 2 h. The combination of age > 15 years, ASA classification ≥ 2, anesthesia time > 2 h, renal failure, and septic shock was included in a model for predicting risk of VTE (AUC = 0.907, sensitivity 84.4%, specificity 88.2%). CONCLUSION VTE is rare in pediatric patients, but prediction modeling may help identify those patients at heightened risk. Additional studies are needed to validate the factors identified in this study in a risk assessment model as well as to assess the efficacy and cost-effectiveness of prophylaxis methods. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Sarah B Cairo
- Department of Pediatric Surgery, John R Oshei Children's Hospital, 1001 Main Street, Buffalo, NY 14202.
| | - Timothy B Lautz
- Department of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611
| | - Beverly A Schaefer
- Department of Pediatric Hematology and Oncology, John R Oshei Children's Hospital, 1001 Main Street, Buffalo, NY 14202; Department of Pediatrics, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263; Department of Pediatrics, State University of New York, University at Buffalo, 3435 Main Street, Buffalo, NY 14214
| | - Guan Yu
- Department of Biostatistics, State University of New York, University at Buffalo, 3435 Main Street, Buffalo, NY 14214
| | - Hibbut-Ur-Rauf Naseem
- Department of Pediatric Surgery, John R Oshei Children's Hospital, 1001 Main Street, Buffalo, NY 14202
| | - David H Rothstein
- Department of Pediatric Surgery, John R Oshei Children's Hospital, 1001 Main Street, Buffalo, NY 14202; Department of Surgery, State University of New York, University at Buffalo, 3435 Main Street, Buffalo, NY 14214
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Cairo SB, Zeinali LI, Yoo EHE, Berkelhamer SK, Rothstein DH. Travel Distance Required to Achieve Regionalization of Esophageal Atresia Repair in the US. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.08.524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Cairo SB, Jacques BF, Elisee B, Nyavandu K, Perry R, Rothstein DH, Kalisya LM. Surgical Repair of Cleft Lip and Palate in North Kivu Province of Eastern Democratic Republic of Congo. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.08.420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kalisya LM, Bake JF, Bigabwa R, Rothstein DH, Cairo SB. Operations for Suspected Neoplasms in a Resource-Limited Setting: Experience and Challenges in the Eastern Democratic of Congo. World J Surg 2018; 42:1913-1918. [PMID: 29290072 DOI: 10.1007/s00268-017-4452-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Surgery is an essential component of a functional health system, with surgical conditions accounting for nearly 11-15% of world disability. While communicable diseases continue to burden low- and low-middle-income countries, non-communicable diseases, such as cancer, are an important cause of morbidity and mortality worldwide. Preliminary data on malignancies in low- and middle-income countries, specifically in Africa, suggest a higher mortality compared to other regions of the world, a difference partially explained by limited availability of screening and early detection systems as well as poorer access to treatment. OBJECTIVE To evaluate the diagnosed tumor burden in the Eastern Democratic Republic of Congo (DRC) and review literature on existing and suspected barriers to accessing appropriate oncologic care. METHODS This is a retrospective study carried out at Healthcare, Education, community Action, and Leadership development Africa, a 197-bed tertiary referral hospital, in the Province of North Kivu, along the eastern border of the DRC from 2012 to 2015. Patient charts were reviewed for diagnoses of presumed malignancy with biopsy results. RESULTS A total of 252 cases of suspected cancer were reviewed during the study period; 39.7% were men. The average age of patients was 43 years. Amongst adult patients, the most common presenting condition involved breast lesions with 5.8% diagnosis of fibrocystic breast changes and 2.9% invasive ductal carcinoma of the breast. 37.3% of female patients had lesions involving the cervix or uterus. The most common diagnosis amongst male adults was prostate disease (16.7% of men). For pediatric patients, the most common diagnoses involved bone and/or cartilage (27.3%) followed by skin and soft tissue lesions (20.0%). All patients underwent surgical resection of lesions; some patients were advised to travel out of country for chemotherapy and radiation for which follow-up data are unavailable. CONCLUSION Adequate and timely treatment of malignancy in the DRC faces a multitude of challenges. Access to surgical services for diagnosis and management as well as chemotherapeutic agents is prohibitively limited. Increased collaboration with local clinicians and remote specialist consultants is needed to deliver subspecialty care in resource-poor settings.
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Affiliation(s)
- Luc Malemo Kalisya
- COSECSA Training Program, HEAL Africa Hospital, Goma, North Kivu, Democratic Republic of Congo
| | - Jacques Fadhili Bake
- COSECSA Training Program, HEAL Africa Hospital, Goma, North Kivu, Democratic Republic of Congo
| | | | - David H Rothstein
- Medicines San Frontiers, Geneva, Switzerland
- Department of Pediatric Surgery, John R Oishei Children's Hospital, 1001 Main Street, Buffalo, NY, 14202, USA
- Department of Surgery, State University of New York at Buffalo, Buffalo, NY, USA
| | - Sarah B Cairo
- Department of Pediatric Surgery, John R Oishei Children's Hospital, 1001 Main Street, Buffalo, NY, 14202, USA.
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Cairo SB, Chiu PPL, Dasgupta R, Diefenbach KA, Goldstein AM, Hamilton NA, Lo A, Rollins MD, Rothstein DH. Transitions in care from pediatric to adult general surgery: Evaluating an unmet need for patients with anorectal malformation and Hirschsprung disease. J Pediatr Surg 2018; 53:1566-1572. [PMID: 29079318 DOI: 10.1016/j.jpedsurg.2017.09.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/10/2017] [Accepted: 09/02/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND The provision of timely and comprehensive transition of care from pediatric to adult surgical providers for patients who have undergone childhood operations remains a challenge. Understanding the barriers to transition from a patient and family perspective may improve this process. METHODS A cross-sectional survey was conducted of patients with a history of anorectal malformation (ARM) or Hirschsprung Disease (HD) and their families. The web-based survey was administered through two support groups dedicated to the needs of individuals born with these congenital abnormalities. Categorical variables were compared using Chi-squared and Fisher's exact test with Student's t test and ANOVA for continuous variables. RESULTS A total of 118 surveys were completed (approximately 26.2% response). The average age of patients at time of survey was 12.3years (SD 11.6) with 64.5% less than 15years old. The primary diagnosis was reported for 78.8% patients and included HD (29.0%), ARM (61.3%), and cloaca (9.7%). The average distance traveled for ongoing care was 186.6miles (SD 278.3) with 40.9% of patients traveling ≥30miles; the distance was statistically significantly greater for patients with ARM (p<0.001). With regards to ongoing symptoms, 44.1% experience constipation, 40.9% experience diarrhea, and approximately 40.9% require chronic medication for management of bowel symptoms; only 3 respondents (3.2%) reported fecal incontinence. The majority of patients, 52.7% reported being seen by a provider at least twice per year and the majority continued to be followed by a pediatric provider, consistent with the majority of the cohort being less than 18years of age. Conversations with providers regarding transitioning to an adult physician had occurred in fewer than 13% of patients. The most commonly cited barrier to transition was the perception that adult providers would be ill-equipped to manage the persistent bowel symptoms. CONCLUSION Patients undergoing childhood procedures for ARM or HD have a high prevalence of ongoing symptoms related to bowel function but very few have had conversations regarding transitions in care. Early implementation of transitional care plans and engagement of adult providers are imperative to transitions and may confer long-term health benefits in this patient population. LEVEL OF EVIDENCE Level IV, case series with no comparison group.
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Affiliation(s)
- Sarah B Cairo
- Women and Children's Hospital of Buffalo, 140 Hodge Street, Buffalo, NY 14222.
| | - Priscilla P L Chiu
- The Hospital for SickKids, 555 University Avenue, Toronto, Canada M5G 1X8.
| | - Roshni Dasgupta
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 35229.
| | - Karen A Diefenbach
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205.
| | - Allan M Goldstein
- Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Boston, MA 02114.
| | - Nicholas A Hamilton
- Oregon Health Sciences University, Doernbecher Children's Hospital, 700 SW Campus Dr, Portland, OR 97239.
| | - Andrea Lo
- The University of Chicago Medicine Comer Children's, 5721 S Maryland Ave, Chicago, IL 60637.
| | - Michael D Rollins
- University of Utah School of Medicine, Primary Children's Hospital, 100 N Mario Capecchi Drive, Salt Lake City, UT 84113.
| | - David H Rothstein
- Women and Children's Hospital of Buffalo, 140 Hodge Street, Buffalo, NY 14222; State University of New York at Buffalo, Department of Surgery, 3435 Main Street, Buffalo, NY 14214.
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Cairo SB, Harmon CM, Rothstein DH. Minimally invasive surgical exposure among US and Canadian pediatric surgery trainees, 2004-2016. J Surg Res 2018; 231:179-185. [PMID: 30278927 DOI: 10.1016/j.jss.2018.05.053] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 05/02/2018] [Accepted: 05/24/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Minimally invasive pediatric surgery has increased in breadth and complexity over the past several decades, with little data on minimally invasive surgery (MIS) training in US and Canadian pediatric surgery fellowship programs. METHODS We performed a time series analysis of Accreditation Council for Graduate Medical Education pediatric surgery fellow case logs from 2003 to 2016. Proportions of cases performed in an MIS fashion as well as per-fellow MIS case averages were recorded over time. RESULTS There was a 30.9% increase in average number of MIS cases per fellow over the study time period. Twenty-three recorded procedures included MIS and open options (17 abdominal, three thoracic, and three genitourinary). The proportion of cases performed using a minimally invasive approach increased by an average of 29.0%, 14.6%, and 47.0% for each of these categories, respectively. Significant variability was observed in specific cases such as laparoscopic and open inguinal hernias, ranging from 0 to 85 and nine to 152 per trainee, respectively, in the final year of data collection. When examining pyloromyotomy, a high-volume procedure with a known increase in the MIS approach, the proportion of cases performed MIS increased by 83.3%. The minimum and maximum number of cases per fellow recorded ranged from 0 to 114 during the eight years in which MIS pyloromyotomy was recorded. CONCLUSIONS MIS case exposure among graduating US and Canadian pediatric survey fellows increased substantially during the study period. More granular data, however, are needed to better define the current operative experience and criteria for determination of competency in advanced MIS.
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Affiliation(s)
- Sarah B Cairo
- Department of Pediatric Surgery, John R. Oishei Children's Hospital of Buffalo, Buffalo, New York.
| | - Carroll M Harmon
- Department of Pediatric Surgery, John R. Oishei Children's Hospital of Buffalo, Buffalo, New York; Department of Surgery, State University of New York, University at Buffalo, Buffalo, New York
| | - David H Rothstein
- Department of Pediatric Surgery, John R. Oishei Children's Hospital of Buffalo, Buffalo, New York; Department of Surgery, State University of New York, University at Buffalo, Buffalo, New York
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Cairo SB, Majumdar I, Pryor A, Posner A, Harmon CM, Rothstein DH. Response to Letter to the Editor; Comments on "Challenges in Transition of Care for Pediatric Patients after Weight-Reduction Surgery: a Systematic Review and Recommendations for Comprehensive Care". Obes Surg 2018; 28:2914-2915. [PMID: 29909516 DOI: 10.1007/s11695-018-3329-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Sarah B Cairo
- Department of Pediatric Surgery, John R Oishei Children's Hospital, 1001 Main Street, Buffalo, NY, 14203, USA.
| | - Indrajit Majumdar
- Division of Endocrinology/Diabetes, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA.,Diabetes Center, John R Oishei Children's Hospital, Buffalo, NY, USA
| | - Aurora Pryor
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Stony Brook Medicine, Stony Brook, NY, USA
| | - Alan Posner
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Division of Surgery, State University of New York, New York, NY, USA
| | - Carroll M Harmon
- Department of Pediatric Surgery, John R Oishei Children's Hospital, 1001 Main Street, Buffalo, NY, 14203, USA.,University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Division of Surgery, State University of New York, New York, NY, USA
| | - David H Rothstein
- Department of Pediatric Surgery, John R Oishei Children's Hospital, 1001 Main Street, Buffalo, NY, 14203, USA.,University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Division of Surgery, State University of New York, New York, NY, USA
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Cairo SB, Fisher M, Clemency B, Cipparone C, Quist E, Bass KD. Prehospital education in triage for pediatric and pregnant patients in a regional trauma system without collocated pediatric and adult trauma centers. J Pediatr Surg 2018. [PMID: 29519567 DOI: 10.1016/j.jpedsurg.2018.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE Patient triage to the appropriate destination is critical to prehospital trauma care. Triage decisions are challenging in a region without collocated pediatric and adult trauma centers. METHODS A regional survey was administered to emergency medical response units identifying variability and confusion regarding factors influencing patient disposition. A course was developed to guide the triage of pediatric and pregnant trauma patients. Pre- and posttests were administered to address course principles, including decision making and triage. RESULTS A total of 445 participants completed the course at 22 sites representing 88 different prehospital provider agencies. Pre- and posttests were administered to 62% of participants with an average score improvement of 53.4% (pretest range 30% to 56.6%; posttest range 85% to 100%). Improvements were seen in all categories including major and minor trauma in pregnancy, major trauma in adolescence, and knowledge of age limits and triage protocols. CONCLUSION Education on triage guidelines and principles of pediatric resuscitation is essential for appropriate prehospital trauma management. Pre- and posttests may be used to demonstrate short term efficacy, while ongoing evaluations of practice patterns and follow-up surveys are needed to demonstrate longevity of acquired knowledge and identify areas of persistent confusion. LEVEL OF EVIDENCE Level IV, Case Series without Standardized.
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Affiliation(s)
- Sarah B Cairo
- John R Oshei Children's Hospital, Department of Pediatric Surgery, Buffalo, NY 14202, United States.
| | - Malachi Fisher
- Women and Children's Hospital of Buffalo, Trauma Injury Prevention and Education, Buffalo, NY 14222, United States
| | - Brian Clemency
- Erie County Medical Center, Department of Emergency Medicine, Buffalo, NY 14215, United States
| | - Charlotte Cipparone
- Jacobs School of Medicine State University of New York at Buffalo, University at Buffalo, Buffalo, New York 14214, United States
| | - Evelyn Quist
- Jacobs School of Medicine State University of New York at Buffalo, University at Buffalo, Buffalo, New York 14214, United States
| | - Kathryn D Bass
- John R Oshei Children's Hospital, Department of Pediatric Surgery, Buffalo, NY 14202, United States; Jacobs School of Medicine State University of New York at Buffalo, Department of Surgery, University at Buffalo, Buffalo, New York 14214, United States
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Cairo SB, Agyei J, Nyavandu K, Rothstein DH, Kalisya LM. Neurosurgical management of hydrocephalus by a general surgeon in an extremely low resource setting: initial experience in North Kivu province of Eastern Democratic Republic of Congo. Pediatr Surg Int 2018; 34:467-473. [PMID: 29453580 DOI: 10.1007/s00383-018-4238-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE Evaluate the management of hydrocephalus in pediatric patients in the Eastern Democratic Republic of Congo by a general surgeon. METHODS Retrospective review of a single institution in the province of North Kivu. Patient charts and surgical notes were reviewed from 2003 to 2016. RESULTS 116 procedures were performed for an average of 8.9 per year. 51.7% of surgeries were on female patients with an average age of 13.6 ± 22.7. The average distance traveled from home to hospital was 153.7 km but ranged from 5 to 1420 km. The majority of hydrocephalus was due to neonatal sepsis (57%); 33.6% were classified as congenital; 9.5% of cases followed myelomeningocele closure. 97.4% had a ventriculoperitoneal (VP) shunt placed. Endoscopic third ventriculostomy combined choroid plexus cauterization (ETV/CPC) was performed in 2.5% of patients. Shunt infection occurred in 9.5% of patients, shunt dysfunction or obstruction in 5.2% and shunt exteriorization in 1.7%; no complications occurred in patients who underwent ETV/CPC. CONCLUSION VP shunt is the predominant management for hydrocephalus in this environment with increasing use of ETV/CPC. Further research is needed to evaluate variability by etiology, short and long-term outcomes of procedures performed by neurosurgeons and general surgeons, and regional epidemiologic variability.
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Affiliation(s)
- Sarah B Cairo
- John R Oishei Children's Hospital, 1001 Main Street, Buffalo, NY, 14203, USA.
| | - Justice Agyei
- Department of Neurosurgery, State University of New York at Buffalo, 955 Main Street, Buffalo, NY, 14203, USA
| | - Kavira Nyavandu
- COSECSA Training Program, HEAL Africa Hospital, Goma, North Kivu, Democratic Republic of Congo
| | - David H Rothstein
- John R Oishei Children's Hospital, 1001 Main Street, Buffalo, NY, 14203, USA.,Department of Surgery, State University of New York at Buffalo, 955 Main Street, Buffalo, NY, 14203, USA
| | - Luc Malemo Kalisya
- COSECSA Training Program, HEAL Africa Hospital, Goma, North Kivu, Democratic Republic of Congo
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Cairo SB, Kalisya LM, Bigabwa R, Rothstein DH. Characterizing pediatric surgical capacity in the Eastern Democratic Republic of Congo: results of a pilot study. Pediatr Surg Int 2018; 34:343-351. [PMID: 29159423 DOI: 10.1007/s00383-017-4215-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Characterize pediatric surgical capacity in the eastern Democratic Republic of Congo (DRC) to identify areas of potential improvement. METHODS The Pediatric Personnel, Infrastructure, Procedures, Equipment, and Supplies (PediPIPES) survey was used in two representative eastern DRC provinces to assess existing surgical infrastructure and capacity. We compared our results to previously published reports from other sub-Saharan African countries. RESULTS Fourteen hospitals in the eastern DRC and 37 in 19 sub-Saharan African (SSA) countries were compared. The average PediPIPES index for the DRC was 7.7 compared to 13.5 for SSAs. The greatest disparities existed in the areas of personnel and infrastructure. Running water was reportedly available to 57.1% of the hospitals in the DRC, and the majority of hospitals (78.6%) were dependent on generators and solar panels for electricity. Only two hospitals in the DRC (14.3%) reported a pediatric surgeon equivalent on staff, compared to 86.5% of facilities sampled in SSA reporting ≥ 1 pediatric surgeon. CONCLUSIONS Significant barriers in personnel, infrastructure, procedures, equipment, and supplies impede the provision of adequate surgical care to children. Further work is needed to assess allocation and utilization of existing resources, and to enhance training of personnel with specific attention to pediatric surgery.
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Affiliation(s)
- Sarah B Cairo
- Department of Pediatric Surgery, John R Oshei Children's Hospital, 1001 Main Street, Buffalo, NY, 14202, USA.
| | - Luc Malemo Kalisya
- HEAL Africa Hospital and College of Surgeons of East, Central and Southern Africa (COSECSA), Goma, Democratic Republic of Congo, Congo
| | - Richard Bigabwa
- Nurse Anesthetist, Goma, Democratic Republic of Congo, Congo
| | - David H Rothstein
- Department of Pediatric Surgery, John R Oshei Children's Hospital, 1001 Main Street, Buffalo, NY, 14202, USA.,Department of Surgery, State University of New York at Buffalo, 3435 Main Street, Buffalo, NY, 14214, USA
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Dorman RM, Ventro G, Cairo SB, Vali K, Rothstein DH. The use of perioperative ketorolac in the surgical treatment of pediatric spontaneous pneumothorax. J Pediatr Surg 2018; 53:456-460. [PMID: 28728827 DOI: 10.1016/j.jpedsurg.2017.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 05/25/2017] [Accepted: 06/14/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND We sought to determine the effect of ketorolac on pediatric primary spontaneous pneumothorax recurrence after operation. METHODS The Pediatric Health Information System database was queried for patients ages 10-16years discharged in the years 2004-2014 with pneumothorax or pleural bleb and a related operative procedure. Deaths and secondary pneumothorax were excluded. Variables included demographics, chronic disease, intensive care unit admission, mechanical ventilation, and lung resection or plication. The primary variable was any ketorolac administration between post-operative day 0 and 5. Outcomes included reintervention within 1year, readmission, post-operative length of stay (LOS), and cost. Bivariate and multivariate logistic regression analyses were performed. RESULTS Of 1678 records that met inclusion criteria, 395 (23%) were subsequently excluded, leaving 1283 patients for analysis. Most patients had a lung resection recorded (78%) and the majority were administered ketorolac (57%); few required reintervention (20%) or readmission (18%). Mean postoperative LOS was 5.2±3.8days and mean cost was $17,649±$10,599. On bivariate analysis, ketorolac administration did not correlate with any measured outcome. On both bivariate and multivariate analysis, no variable was predictive of reintervention, and only lung resection correlated with readmission (adjusted odds ratio 0.63 [95% C.I. 0.45-0.90]). CONCLUSION Post-operative ketorolac administration was not associated with an increased likelihood of reintervention or readmission within 1year of operative treatment of primary spontaneous pneumothorax, suggesting that it may be used safely as part of a post-operative pain control regimen. Effects on postoperative length of stay and cost, however, were not demonstrated. LEVEL OF EVIDENCE AND TYPE OF STUDY Level III treatment study.
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Affiliation(s)
- R Michael Dorman
- Department of Surgery, University at Buffalo, SUNY; Department of Pediatric Surgery, Women and Children's Hospital of Buffalo.
| | - George Ventro
- Department of Surgery, University at Buffalo, SUNY; Department of Pediatric Surgery, Women and Children's Hospital of Buffalo
| | - Sarah B Cairo
- Department of Pediatric Surgery, Women and Children's Hospital of Buffalo
| | - Kaveh Vali
- Department of Surgery, University at Buffalo, SUNY; Department of Pediatric Surgery, Women and Children's Hospital of Buffalo
| | - David H Rothstein
- Department of Surgery, University at Buffalo, SUNY; Department of Pediatric Surgery, Women and Children's Hospital of Buffalo
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Cairo SB, Majumdar I, Pryor A, Posner A, Harmon CM, Rothstein DH. Challenges in Transition of Care for Pediatric Patients after Weight-Reduction Surgery: a Systematic Review and Recommendations for Comprehensive Care. Obes Surg 2018; 28:1149-1174. [DOI: 10.1007/s11695-018-3138-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
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Cairo SB, Raval MV, Browne M, Meyers H, Rothstein DH. Association of Same-Day Discharge With Hospital Readmission After Appendectomy in Pediatric Patients. JAMA Surg 2018; 152:1106-1112. [PMID: 28678998 DOI: 10.1001/jamasurg.2017.2221] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Importance Appendectomy is the most common abdominal operation performed in pediatric patients in the United States. Studies in adults have suggested that same-day discharge (SDD) after appendectomy is safe and does not result in higher-than-expected hospital readmissions. Objective To evaluate the influence of SDD on 30-day readmission rates following appendectomy for acute appendicitis in pediatric patients. Design, Setting, and Participants This retrospective cohort study used the American College of Surgeons National Surgical Quality Improvement Program-Pediatric database to evaluate 30-day readmission rates among pediatric patients who underwent an appendectomy for acute, nonperforated appendicitis. The database provides high-quality surgical outcomes data from more than 80 participating US hospitals, including free-standing pediatric facilities, children's hospitals, specialty centers, children's units within adult hospitals, and general acute care hospitals with a pediatric wing. Patients selected for inclusion (n = 22 771) were between ages 0 and 17 years and underwent appendectomy for uncomplicated appendicitis between January 1, 2012, and December 31, 2015. Patients excluded were those discharged more than 2 days after surgery. Exposures Same-day discharge after appendectomy or discharge 1 or 2 days after surgery. Main Outcomes and Measures The primary outcome was 30-day readmission. Secondary outcomes included surgical-site infections and other wound complications. Results Of the 20 981 patients, 4662 (22.2%) had SDD and 16 319 (77.8%) were discharged within 1 or 2 days after surgery. The patient cohort included 12 860 boys (61.3%) and 8121 girls (38.7%), with a mean (SD) age of 11.0 (3.56) years. There was no difference in the odds of readmission for patients with SDD compared with those discharged within 2 days (adjusted odds ratio [aOR], 0.82; 95% CI, 0.51-1.04; P = .06; readmission rate, 1.89% vs 2.33%). There was no significant difference in reason for readmission on the basis of discharge timing. Likewise, there was no difference in wound complication rate between patients with SDD and those discharged 1 or 2 days after surgery (aOR 0.75; 95% CI, 0.56-1.01; P = .06). Conclusions and Relevance In pediatric patients with acute appendicitis undergoing appendectomy, SDD is not associated with an increase in 30-day hospital readmission rates or wound complications when compared with discharge 1 or 2 days after surgery. Same-day discharge may be an applicable quality metric for the provision of safe and efficient care for pediatric patients with acute, nonperforated appendicitis.
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Affiliation(s)
- Sarah B Cairo
- Pediatric Surgery, Women and Children's Hospital of Buffalo, Buffalo, New York
| | - Mehul V Raval
- Department of Pediatric Surgery, Children's Healthcare of Atlanta, Atlanta, Georgia.,Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Marybeth Browne
- Department of Pediatric Surgery, Lehigh Valley Children's Hospital, Allentown, Pennsylvania
| | - Holly Meyers
- Pediatric Surgery, Women and Children's Hospital of Buffalo, Buffalo, New York
| | - David H Rothstein
- Pediatric Surgery, Women and Children's Hospital of Buffalo, Buffalo, New York.,Department of Surgery, University at Buffalo, Buffalo, New York
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Cairo SB, Ventro G, Meyers HA, Rothstein DH. Influence of discharge timing and diagnosis on outcomes of pediatric laparoscopic cholecystectomy. Surgery 2017; 162:1304-1313. [DOI: 10.1016/j.surg.2017.07.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/23/2017] [Accepted: 07/27/2017] [Indexed: 01/01/2023]
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Abstract
PURPOSE To examine the effects of obesity on specialty-specific surgical outcomes in children. MATERIALS AND METHODS Retrospective cohort study using the National Surgical Quality Improvement Program, Pediatric, 2012-2014. Patients included those aged 2-17 years who underwent a surgical procedure in one of six specialties. Obesity was the primary patient variable of interest. Outcomes of interest were postoperative complications and operative times. Odds ratios for development of postoperative complications were calculated using stepwise multivariate regression analysis. RESULTS Obesity was associated with a significantly greater risk of wound complications (OR 1.24, 95% CI 1.13-1.36), but decreased risk of non-wound complications (OR 0.68, 95% CI 0.63-0.73) and morbidity (OR 0.79, 95% CI 0.75-0.84). Obesity was not a significant factor in predicting postoperative complications in patients undergoing otolaryngology or plastic surgery procedures. Anesthesia times and operative times were significantly longer for obese patients undergoing most types of pediatric surgical procedures. CONCLUSION Obesity confers an increased risk of wound complications in some pediatric surgical specialties and is associated with overall decreased non-wound complications and morbidity. These findings suggest that the relationship between obesity and postoperative complications is complex and may be more dependent on underlying procedure- or specialty-related factors than previously suspected.
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Affiliation(s)
- A T Train
- Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, 219 Bryant Street, Buffalo, NY, 14222, USA.
| | - S B Cairo
- Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, 219 Bryant Street, Buffalo, NY, 14222, USA
| | - H A Meyers
- Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, 219 Bryant Street, Buffalo, NY, 14222, USA
| | - C M Harmon
- Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, 219 Bryant Street, Buffalo, NY, 14222, USA.,Department of Surgery, University at Buffalo, The State University of New York, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - D H Rothstein
- Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, 219 Bryant Street, Buffalo, NY, 14222, USA.,Department of Surgery, University at Buffalo, The State University of New York, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
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Cairo SB, Naseem HUR, Rothstein DH. Risk Factors for Venous Thromboembolic Events in Pediatric Surgical Patients: Defining When Prophylaxis Is Indicated. J Am Coll Surg 2017. [DOI: 10.1016/j.jamcollsurg.2017.07.901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cairo SB, Kalisya LM, Bigabwa Bahirwe RR, Rothstein DH. Evaluating Pediatric Surgical Capacity in the Eastern Democratic Republic of Congo: Results of a Pilot Study. J Am Coll Surg 2017. [DOI: 10.1016/j.jamcollsurg.2017.07.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cairo SB, Chiu PP, Goldstein AM, Hamilton NA, Lo A, Rollins MD, Rothstein DH. Transitions in Care from Pediatric to Adult General Surgery: Evaluating an Unmet Need. J Am Coll Surg 2017. [DOI: 10.1016/j.jamcollsurg.2017.07.841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cairo SB, Bake JF, Kalisya LM, Bigabwa Bahirwe RR, Rothstein DH. Cancer and Access to Surgical Care in a Resource Limited Setting: Experience and Challenges in the Eastern Democratic Republic of Congo. J Am Coll Surg 2017. [DOI: 10.1016/j.jamcollsurg.2017.07.795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Cairo SB, Tabak B, Harmon CM, Bass KD. Novel use of porcine extracellular matrix in recurrent stricture following repair of tracheoesophageal fistula. Pediatr Surg Int 2017; 33:1027-1033. [PMID: 28756526 DOI: 10.1007/s00383-017-4130-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2017] [Indexed: 01/07/2023]
Abstract
Anastomotic stricture is a common complication following repair of esophageal atresia (EA). Many factors are thought to contribute to stricture formation and a variety of management techniques have been developed. In this case report, we describe the treatment of a recurrent anastomotic stricture following repair of long-gap esophageal atresia. Porcine bladder extracellular matrix (ECM) was mounted on a stent and delivered endoscopically to the site of recurrent stricture. An appropriate positioning was confirmed using direct endoscopic visualization and intra-operative fluoroscopy. The patient recovered well with persistent radiographic and functional improvements in previous stricture.
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Affiliation(s)
- Sarah B Cairo
- Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, 219 Bryant Street, Buffalo, NY, 14222, USA.
| | - Benjamin Tabak
- Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, 219 Bryant Street, Buffalo, NY, 14222, USA
| | - Carroll M Harmon
- Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, 219 Bryant Street, Buffalo, NY, 14222, USA.,Department of Surgery, University at Buffalo, State University of New York School of Medicine and Bioscience, Buffalo, NY, USA
| | - Kathryn D Bass
- Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, 219 Bryant Street, Buffalo, NY, 14222, USA.,Department of Surgery, University at Buffalo, State University of New York School of Medicine and Bioscience, Buffalo, NY, USA
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