Six Years of Quality Improvement in Pectus Excavatum Repair: Implementation of Intercostal Nerve Cryoablation and ERAS Protocols for Patients Undergoing Nuss Procedure.

Background: The Nuss procedure for pectus excavatum is associated with prolonged hospitalizations due to pain. We evaluated implementation of intercostal nerve cryoablation and enhanced recovery after surgery (ERAS) protocols on outcomes of Nuss procedures performed over six years at a single institution.

Methods: This retrospective cohort study included patients who underwent Nuss procedure from 10/2017 to 09/2023.

Stepwise training program: A novel practice schedule for laparoscopic suturing.

Purpose: We establish stepwise training program in which laparoscopic suturing is broken down to discrete steps. The purpose is to evaluate the learning outcomes of stepwise training program.

Materials And Methods: Volunteer participants were enrolled from medical students and surgical trainees.

Wound Classification Score Discordance in Pediatric Operations - A Quality Improvement Study.

Background: Wound classification scores are used to categorize the risk of postoperative infections. It was noted at our academic institution that wound classifications were often inaccurately recorded in the electronic health record. We thus instituted a quality improvement program, hypothesizing that this would improve charting accuracy.

Variation in pediatric cervical spine imaging across trauma centers-A cause for concern?

Background: Traumatic pediatric cervical spine injury can be challenging to diagnose, and the clinical algorithms meant to aid physicians differ from adult trauma protocols. Despite the existence of standardized guidelines, imaging decisions may vary according to physician education, subjective assessment, and experience with pediatric trauma patients. Our study investigates the rates of pediatric posttraumatic cervical spine imaging across trauma centers, hypothesizing that more specialized centers will have lower rates of advanced cervical spine imaging.

The role of ECMO in the management of congenital diaphragmatic hernia.

Congenital diaphragmatic hernia (CDH) is the most common indication for extra-corporeal membrane oxygenation (ECMO) for neonatal respiratory failure. CDH management is evolving with advanced prenatal diagnostic imaging modalities. The risk profiles of infants receiving ECMO for CDH are shifting towards higher risk.

Differences in Outcomes Based on Sex for Pediatric Patients Undergoing Pyloromyotomy.

Background: Males and females are known to have varied responses to medical interventions. Our study aimed to determine the effect of sex on surgical outcomes after pyloromyotomy.

Materials And Methods: Using the Kids' Inpatient Database for the years 2003-2012, we performed a serial, cross-sectional analysis of a nationally representative sample of all patients aged <1 y who underwent pyloromyotomy for hypertrophic pyloric stenosis.

Attitudes and Beliefs of Pediatric Surgical Specialists on Costs of Care and High Deductible Health Plans.

Health care consumers are burdened with rising out-of-pocket medical expenses. Surgical specialists' experience and attitude towards patients' out-of-pocket costs and the influence of these factors on healthcare utilization are unknown. Our aim was to define the pediatric surgeons' experience with the financial concerns of their patients.

Complications of pediatric cholecystectomy: impact from hospital experience and use of cholangiography.

Background: Complications after cholecystectomy in children are poorly characterized. The aim of this study was to assess risk factors for major surgical complications for children undergoing cholecystectomy.

Study Design: All children 4 to 18 years old with gallbladder disease who underwent cholecystectomy from 1999 to 2006 were identified from the California Patient Discharge Database.

Hospital type as a metric for racial disparities in pediatric appendicitis.

Background: Appendiceal perforation (AP) is a marker of health care disparities. We propose that racial disparities in children, as measured by AP, may change according to the type of hospital in which a child receives care.

Study Design: Children 2 to 18 years old, with appendicitis diagnosed from 1999 to 2007, were retrospectively reviewed from the California Patient Discharge Dataset and sorted by community, children's, and county hospitals.

Postoperative complications and health care use in children undergoing surgery for ulcerative colitis.

Objectives: Medical and surgical approaches toward children with ulcerative colitis (UC) vary and have differing implications for health care use. The goal of this study was to define hospital use and complications for children with UC before and after staged restorative proctocolectomy.

Patients And Methods: A retrospective study of the California Patient Discharge Dataset from 1999 to 2007 of children aged 2 to 18 years with UC who underwent colectomy was performed (N = 218).

Hospital type predicts surgical complications for infants with hypertrophic pyloric stenosis.

Pyloromyotomy is a common surgery performed for hypertrophic pyloric stenosis at community and children's hospitals. To determine hospital-level factors that may affect clinical outcomes, infants requiring pyloromyotomy from 1999 to 2007 (n=8379) were retrospectively reviewed from the California linked birth cohort data set. Hospital case volume and type (community, children's, adult hospital with children's unit) were examined.

Does hospital transfer predict mortality in very low birth weight infants requiring surgery for necrotizing enterocolitis?

Background: Necrotizing enterocolitis (NEC) is a leading cause of infant mortality, and the most common reason for emergent surgery in very low birth weight (VLBW, < 1,500 g) infants. We investigated whether transfer for higher level of surgical care affects mortality in this population.

Methods: VLBW infants who underwent NEC surgery were reviewed retrospectively from the California Patient Discharge Linked Birth Cohort Database (1999-2007).

Predictors of proctocolectomy in children with ulcerative colitis.

Objectives: Few clinical predictors are associated with definitive proctocolectomy in children with ulcerative colitis (UC). The purpose of the present study was to identify clinical predictors associated with surgery in children with UC using a disease-specific database.

Methods: Children diagnosed with UC at age <18 years were identified using the Pediatric Inflammatory Bowel Disease Consortium (PediIBDC) database.

Outcomes of bariatric surgery in adolescents.

Purpose Of Review: The review summarizes the recent studies of bariatric surgery outcomes in adolescents.

Recent Findings: Randomized prospective studies demonstrate superior weight loss, resolution of comorbidities, and improvement in quality of life in morbidly obese adolescents undergoing bariatric surgery vs. lifestyle changes alone.

Closing the gap between insecticide treated net ownership and use for the prevention of malaria.

Background: Malaria is the leading cause of morbidity and mortality in children younger than 5 years old and pregnant women in sub-Saharan Africa. Insecticide-treated nets (ITNs) reduce clinical malaria by more than 50% and all cause mortality in young children by 15% to 30%. However, use of these nets is poor across sub-Saharan Africa, limiting the potential impact of this effective tool in the fight against malaria.

Trends and outcomes of adolescent bariatric surgery in California, 2005-2007.

Objective: The goal of this study was to evaluate trends, and outcomes of adolescents who undergo bariatric surgery.

Patients And Methods: Patients younger than 21 years who underwent elective bariatric surgery between 2005 and 2007 were identified from the California Office of Statewide Health Planning and Development database. Multivariate logistic regression was used to identify factors associated with the type of surgery.

Disparity in management and long-term outcomes of pediatric splenic injury in California.

Objective: To determine the impact of evidence-based guidelines on the disparities in management of pediatric splenic injuries (PSI).

Summary Of Background Data: Several studies have highlighted a disparity in the utilization of nonoperative management (NOM) for PSI based on hospital and surgeon characteristics. Whether evidence-based guidelines had an impact on mitigating this disparity is uncertain.

Hospital readmissions and survival after nonneonatal pediatric ECMO.

Purpose: The late effects of treatment with extracorporeal membrane oxygenation (ECMO) in nonneonatal pediatric patients remain unclear. The aims of our study were to better characterize the long-term survival and hospital readmission rates for pediatric patients after ECMO treatment.

Patients And Methods: From 1999 to 2006, data on children aged 1 month to 18 years who underwent ECMO were extracted from the California Patient Discharge Database.

Laparoscopic versus open appendectomy in children: outcomes comparison based on a statewide analysis.

Background: To compare the differences in hospital utilization and complications between laparoscopic (LA) and open appendectomy (OA) for pediatric appendicitis.

Methods: A retrospective study from 1999 to 2006 of children aged 1 to 18 y with appendicitis, from the California Patient Discharge Database was performed. Children with significant comorbidities were excluded.

Creation of inpatient capacity during a major hospital relocation: lessons for disaster planning.

Objective: To identify tools to aid the creation of disaster surge capacity using a model of planned inpatient census reduction prior to relocation of a university hospital.

Design: Prospective analysis of hospital operations for 1-week periods beginning 2 weeks (baseline) and 1 week (transition) prior to move day; analysis of regional hospital and emergency department capacity.

Setting: Large metropolitan university teaching hospital.

The impact of hospital type and experience on the operative utilization in pediatric intussusception: a nationwide study.

Purpose: To determine the impact in clinical outcomes of pediatric idiopathic intussusceptions from hospital experience and designation as children's hospitals (CH) and non-children's hospitals (NCH) in the US.

Methods: A retrospective study was performed on 1263 children with idiopathic intussusception, 2 months to 3 years of age in 2000 and 2003 by extracting data from the Healthcare Cost and Utilization Project Kid's Inpatient Database. Main outcome measures were utilizations of operation and radiologic reduction.

Hospital differences in short-term outcomes for uncomplicated pediatric patients with gallbladder disease.

Purpose: To examine the differences in short-term outcomes and laparoscopic cholecystectomy rates between children's hospitals and non-children's hospitals for uncomplicated pediatric gallbladder disease.

Methods: A retrospective study was performed of cholecystectomy patients aged 4 to 12 years in 2003 from the Kid's In-Patient Database. Patients with significant comorbidities were excluded.