Antibiotic Stewardship through Use of a Preferred Antibiotic Regimen is Associated with Decreased Organ Space Surgical Site Infections in Uncomplicated and Complicated Pediatric Appendicitis.

There is a lack of consensus on the optimal antibiotic regimen for pediatric appendicitis, and conflicting data exist regarding the need for extended-spectrum use in this population. We implemented an antibiotic stewardship program with a standard, preferred antibiotic regimen for both uncomplicated and complicated appendicitis and hypothesized that clinical outcomes would be equivalent. This is a single-institution, retrospective study of pediatric patients (≤18 y) who underwent appendectomy for acute appendicitis between October 2015 and May 2022.

National Trends in the Creation of Diverting Ileostomy at the Time of Ileal Pouch-Anal Anastomosis in Adults With Ulcerative Colitis.

Introduction: The impact of diverting ileostomy in adults with ulcerative colitis (UC) undergoing ileal pouch-anal anastomosis (IPAA) is unclear. This study uses a novel approach with population-level data to identify patients with diverting ileostomy at the time of IPAA and determine the impact of diverting ileostomy on postoperative outcomes.

Methods: Using the International Business Machines (IBM) MarketScan® database, adults (18-64 years old) with a diagnosis of UC who underwent IPAA between 2000 and 2019 were examined.

Neighborhood child opportunity is associated with hospital length of stay following pediatric burn injury.

Introduction: Pediatric burns are associated with socioeconomic disadvantage and lead to significant morbidity. The Child Opportunity Index (COI) is a well-validated measure of neighborhood characteristics associated with healthy child development. We sought to evaluate the relationship between COI and outcomes of burn injuries in children.

Outcomes in Obese Adult Veno-Venous Extracorporeal Membrane Oxygenation: A Systematic Review.

Obesity is associated with an overall increased risk of morbidity and mortality. However, in patients with critical illness, sepsis, and acute respiratory distress syndrome, obesity may be protective, termed "the obesity paradox." This is a systematic literature review of articles published from 2000 to 2022 evaluating complications and mortality in adults with respiratory failure on veno-venous extracorporeal membrane oxygenation (VV ECMO) based on body mass index (BMI).

Major trauma in pregnancy: prediction of maternal and perinatal adverse outcomes.

Background: Trauma, largely the consequence of motor vehicle crashes, is the leading cause of pregnancy-associated maternal mortality. Prediction of adverse outcomes has been difficult in pregnancy given the infrequent occurrence of traumatic events and anatomic considerations unique to pregnancy. The injury severity score, an anatomic scoring system with weighting dependent on severity and anatomic region of injury, is used in the prediction of adverse outcomes in the nonpregnant population but has yet to be validated in pregnancy.

Difference in Postoperative Outcomes and Perioperative Resource Utilization Between General Surgeons and Pediatric Surgeons: A Systematic Review.

Both general surgeons (GS) and pediatric surgeons (PS) perform a high volume of appendectomies in pediatric patients, but there is a paucity of data on these outcomes based on surgeon training. We performed a systematic review and meta-analysis to compare postoperative outcomes and perioperative resource utilization for pediatric appendectomies. We searched PubMed to identify articles examining the association between surgeon specialization and outcomes for pediatric patients undergoing appendectomies.

Nonoperative Management Versus Laparoscopic Appendectomy in Children: A Cost-Effectiveness Analysis.

Introduction: Nonoperative management (NOM) of acute appendicitis in the pediatric population is highly debated with uncertain cost-effectiveness. We performed a decision tree cost-effectiveness analysis of NOM versus early laparoscopic appendectomy (LA) for acute appendicitis in children.

Methods: We created a decision tree model for a simulated cohort of 49,000 patients, the number of uncomplicated appendectomies performed annually, comparing NOM and LA.

Accuracy and utilization patterns of intraabdominal imaging for major trauma in pregnancy.

Background: Imaging protocols for major maternal trauma during pregnancy are not standardized, and it is uncertain whether focused assessment with sonography for trauma or computed tomography of the abdomen/pelvis is preferred for detecting intraabdominal hemorrhage.

Objective: This study aimed to estimate the accuracy of focused assessment with sonography for trauma compared with computed tomography of the abdomen/pelvis, validate imaging accuracy with clinical outcomes, and describe clinical factors associated with each imaging mode.

Study Design: A retrospective cohort study of pregnant patients evaluated for major trauma at one of two Level 1 trauma centers between 2003 and 2019.

Appendectomy by Pediatric Surgeons in North Carolina is Associated With Higher Charge Than General Surgeons.

Introduction: The delivery of pediatric surgical care for acute appendicitis involves general surgeons (GS) and pediatric surgeons (PS), but the differences in clinical practice are primarily undescribed. We examined charge differences between GS and PS for the treatment of pediatric acute appendicitis.

Methods: We performed a retrospective review of the North Carolina hospital discharge database (2013-2017) in pediatric patients (≤18 y) who had surgery for appendiceal pathology (acute or chronic appendicitis and other appendiceal pathology).

The role of extracorporeal membrane oxygenation in adult kidney transplant patients: A qualitative systematic review of literature.

Background: A paucity of evidence exists regarding the risks and benefits of Extracorporeal Membrane Oxygenation (ECMO) in adult kidney transplantation.

Methods: This was a systematic review conducted from Jan 1, 2000 to April 24, 2020 of adult kidney transplant recipients (pre- or post- transplant) and donors who underwent veno-arterial or veno-venous ECMO cannulation. Death and graft function were the primary outcomes, with complications as secondary outcomes.

Cholecystectomies performed in children by pediatric surgeons compared to general surgeons in North Carolina are associated with higher institutional charges.

Introduction: The delivery of pediatric surgical care for gallbladder (GB) and biliary disease involves both General Surgeons (GS) and Pediatric Surgeons (PS). There is a lack of data describing how surgeon specialty impacts practice patterns and healthcare charges.

Methods: We performed a retrospective review of the North Carolina Inpatient Hospital Discharge Database (2013-2017) on pediatric patients (≤18 years) undergoing surgery for biliary pathology.

Posthospitalization outcomes after extracorporeal membrane oxygenation (ECMO) for COVID-19.

Background: Critical illness from COVID-19 is associated with prolonged hospitalization and high mortality rates. Extracorporeal membrane oxygenation is used for refractory severe acute respiratory distress syndrome in COVID-19 with outcomes comparable to other indications for extracorporeal membrane oxygenation. However, long-term functional outcomes have yet to be fully elucidated.

Professionalism of Admitting and Consulting Services and Trauma Patient Outcomes.

Objective: To determine whether trauma patients managed by an admitting or consulting service with a high proportion of physicians exhibiting patterns of unprofessional behaviors are at greater risk of complications or death.

Summary Background Data: Trauma care requires high-functioning interdisciplinary teams where professionalism, particularly modeling respect and communicating effectively, is essential.

Methods: This retrospective cohort study used data from 9 level I trauma centers that participated in a national trauma registry linked with data from a national database of unsolicited patient complaints.

Major Bleeding and Thrombosis Events in COVID-19 Versus Influenza Patients Requiring Extracorporeal Membrane Oxygenation.

Initial reports described a hypercoagulable state and an increased risk of thrombosis in patients who tested positive for SARS-CoV-2. Infected patients with severe acute respiratory distress syndrome in the setting of coronavirus disease 2019 (COVID-19) may require extracorporeal membrane oxygenation (ECMO), leading to coagulopathies and further increasing the risk for bleeding and thrombosis. We conducted a single-center retrospective cohort study to compare the incidence of major bleeding and thrombosis in COVID-19 versus influenza-positive patients requiring ECMO.

The role of extracorporeal membrane oxygenation in adult liver transplant patients: A qualitative systematic review of literature.

Background: A paucity of evidence exists regarding risks and benefits of extracorporeal membrane oxygenation (ECMO) in adult liver transplantation.

Methods: This was a systematic review conducted from January 1, 2000 to April 24, 2020 of adult liver transplant recipients (pre- or post-transplant) and donors who underwent Veno-arterial or Veno-venous ECMO cannulation. Death was the primary outcome, with graft function and complications as secondary outcomes.

Treatment of Acute Severe Asthma Exacerbation with Extracorporeal Membrane Oxygenation and Inhaled Volatile Anesthetic.

Severe asthma affects approximately 1-2% of all asthmatic patients. Acute exacerbations are associated with high mortality in this population. There are many treatment options for asthma exacerbation; however, if these treatments fail, patients can develop progressive hypoxia, hypercarbia, respiratory acidosis, and hemodynamic instability.

The Impact of General Surgeons on Pediatric Surgical Practice in North Carolina: The Reality of Pediatric Surgical Care Delivery.

Objective: The aim of this study was to define the training background of the actual surgical workforce providing care to pediatric patients in North Carolina (NC).

Background: Due to database limitations, pediatric surgical workforce studies have not included general surgeons (GS) who operate on children. Defining the role of GS in care delivery affects policy for clinical care and general and pediatric surgical training.

Socioeconomic disparities in ostomy reversal among older adults with diverticulitis are more substantial among non-Hispanic Black patients.

Background: While ostomies for diverticulitis are often intended to be temporary, ostomy reversal rates can be as low as 46%. There are few comprehensive studies evaluating the effects of socioeconomic status as a disparity in ostomy reversal. We hypothesized that among the elderly Medicare population undergoing partial colectomy for diverticulitis, lower socioeconomic status would be associated with reduced reversal rates.

Comparative outcomes between COVID-19 and influenza patients placed on veno-venous extracorporeal membrane oxygenation for severe ARDS.

Background: ECMO is an established supportive adjunct for patients with severe, refractory ARDS from viral pneumonia. However, the exact role and timing of ECMO for COVID-19 patients remains unclear.

Methods: We conducted a retrospective comparison of the first 32 patients with COVID-19-associated ARDS to the last 28 patients with influenza-associated ARDS placed on V-V ECMO.

Characteristics and outcomes following motorized and non-motorized vehicular trauma in a resource-limited setting.

Introduction: Despite the ubiquity of motorized vehicular transport, non-motorized transportation continues to be common in sub-Saharan Africa.

Methods: We performed a retrospective analysis of trauma patients presenting to Kamuzu Central Hospital in Malawi from February 2008 to May 2018. Demographic and clinical variables including injury characteristics and outcomes were collected.

Time to Cannulation after ICU Admission Increases Mortality for Patients Requiring Veno-venous ECMO for COVID-19 Associated Acute Respiratory Distress Syndrome.

Objective: COVID-19 can cause ARDS that is rapidly progressive, severe, and refractory to conventional therapies. ECMO can be used as a supportive therapy to improve outcomes but evidence-based guidelines have not been defined.

Summary Background Data: Initial mortality rates associated with ECMO for ARDS in COVID-19 were high, leading some to believe that there was no role for ECMO in this viral illness.