Environmental Impact of Traveling to the Annual American Pediatric Surgical Association Meeting.

Purpose: Research has demonstrated negative environmental impacts from in-person conferences. Nonetheless, there are benefits to in-person meetings. The 2023 American Pediatric Surgical Association (APSA) meeting was mostly attended in-person.

Attitudes on Artificial Intelligence use in Pediatric Care From Parents of Hospitalized Children.

Introduction: Artificial intelligence (AI) may benefit pediatric healthcare, but it also raises ethical and pragmatic questions. Parental support is important for the advancement of AI in pediatric medicine. However, there is little literature describing parental attitudes toward AI in pediatric healthcare, and existing studies do not represent parents of hospitalized children well.

Technical/Algorithm, Stakeholder, and Society (TASS) barriers to the application of artificial intelligence in medicine: A systematic review.

Introduction: The use of artificial intelligence (AI), particularly machine learning and predictive analytics, has shown great promise in health care. Despite its strong potential, there has been limited use in health care settings. In this systematic review, we aim to determine the main barriers to successful implementation of AI in healthcare and discuss potential ways to overcome these challenges.

Complication rates in very low and extremely low birth weight infants following laparotomy: a prospective study.

Introduction: Surgical site occurrences (SSO), including surgical site infection, dehiscence, and incisional hernia, are complications following laparotomy. SSO rates in premature neonates are poorly understood. We hypothesize that SSO rates are higher among extremely low birth weight (ELBW) infants compared to very low birth weight (VLBW) infants and strive to determine the optimal abdominal closure method for these infants.

Confidence-based laboratory test reduction recommendation algorithm.

Background: We propose a new deep learning model to identify unnecessary hemoglobin (Hgb) tests for patients admitted to the hospital, which can help reduce health risks and healthcare costs.

Methods: We collected internal patient data from a teaching hospital in Houston and external patient data from the MIMIC III database. The study used a conservative definition of unnecessary laboratory tests, which was defined as stable (i.

Costs associated with postoperative intra-abdominal abscess in pediatric perforated appendicitis: A retrospective cohort study.

Background: Intra-abdominal abscess, the most common complication after perforated appendicitis, is associated with considerable economic burden. However, costs of intra-abdominal abscesses in children are unknown. We aimed to evaluate resource utilization and costs attributable to intra-abdominal abscess in pediatric perforated appendicitis.

External Validation of a Laboratory Prediction Algorithm for the Reduction of Unnecessary Labs in the Critical Care Setting.

Background: Unnecessary laboratory tests contribute to iatrogenic harm and are a major source of waste in the health care system. We previously developed a machine learning algorithm to help clinicians identify unnecessary laboratory tests, but it has not been externally validated. In this study, we externally validate our machine learning algorithm.

Variability in opioid prescribing practices, knowledge, and beliefs: A survey of providers caring for pediatric surgical patients.

Background/purpose: Comprehensive opioid stewardship programs require collective stakeholder alignment and proficiency. We aimed to determine opioid-related prescribing practices, knowledge, and beliefs among providers who care for pediatric surgical patients.

Methods: A single-center, cross-sectional survey was conducted of attending physicians, residents, and advanced practice providers (APPs), who managed pediatric surgical patients.

Cryoanalgesia enhances recovery from minimally invasive repair of pectus excavatum resulting in reduced length of stay: A case-matched analysis of NSQIP-Pediatric patients.

Purpose: Pain control is challenging after minimally invasive repair of pectus excavatum (MIRPE). Cryoanalgesia, which temporarily ablates peripheral nerves, improves pain control and may accelerate post-operative recovery. We hypothesized that cryoanalgesia would be associated with shorter length of stay (LOS) in children undergoing MIRPE.

Variation in opioid utilization among neonates with gastroschisis.

Purpose: Repetitive painful stimuli and early exposure to opioids places neonates at risk for neurocognitive delays. We aimed to understand opioid utilization for neonates with gastroschisis.

Methods: We performed a retrospective review of infants with gastroschisis at a tertiary children's hospital (2017-2019).

Prophylactic intraabdominal drains do not confer benefit in pediatric perforated appendicitis: Results from a quality improvement initiative.

Background/purpose: Prophylactic, intraabdominal drains have been used to prevent intraabdominal abscess (IAA) after perforated appendicitis. We hypothesized that routine drain placement would reduce the IAA rate in pediatric perforated appendicitis.

Methods: A 27-month quality improvement (QI) initiative was conducted: closed-suction, intraabdominal drains were placed intraoperatively in pediatric (age < 18) perforated appendicitis patients.

User-centered design of discharge warnings tool for colorectal surgery patients.

Objectives: Readmission following colorectal surgery, typically due to surgery-related complications, is common. Patient-centered discharge warnings may guide recognition of early complication signs after colorectal surgery.

Materials And Methods: User-centered design of a discharge warnings tool consisted of iterative health literacy review and a heuristic evaluation with human factors and clinical experts as well as patient end users to establish content validity and usability.

Analysis of model development strategies: predicting ventral hernia recurrence.

Background: There have been many attempts to identify variables associated with ventral hernia recurrence; however, it is unclear which statistical modeling approach results in models with greatest internal and external validity. We aim to assess the predictive accuracy of models developed using five common variable selection strategies to determine variables associated with hernia recurrence.

Methods: Two multicenter ventral hernia databases were used.

Patterns of Care for Colorectal Liver Metastasis Within an Integrated Health System: Secular Trends and Outcomes.

Background: Utilization of evidence-based treatments for patients with colorectal liver metastasis (CRC-LM) outside high-volume centers is not well-characterized. We sought to describe trends in treatment and outcomes, and identify predictors of therapy within a nationwide integrated health system.

Methods: Observational cohort study of patients with CRC-LM treated within the Veterans Affairs (VA) health system (1998-2012).

Ninety-day readmission after colorectal cancer surgery in a Veterans Affairs cohort.

Background: Readmissions following colorectal surgery are common. However, there are limited data examining unplanned readmissions (URs) after colorectal cancer (CRC) surgery. The goal of this study was to identify reasons and predictors of UR, and to examine their clinical impact on CRC patients.

Primary Tumor Resection and Multimodality Treatment for Patients with Metastatic Colon Cancer.

Background: Although controversial, recent data suggest a benefit associated with primary tumor resection (PTR) in metastatic colon cancer (mCC) patients. However, utilization of the various management strategies over time relative to surgery, in particular multimodality treatment (MMT), as well as the impact of age on treatment remains unclear.

Study Design: Historical cohort study of mCC patients in the National Cancer Data Base (1998-2009).

Causes and Rates of Unplanned Readmissions After Elective Primary Total Joint Arthroplasty: A Systematic Review and Meta-Analysis.

To address the lack of consensus on the leading reasons for readmissions after primary elective unilateral total joint arthroplasties (TJAs), we performed a systematic review and a meta-analysis to identify overall and cause-specific readmission rates. We performed structured searches of the Medline and Cochrane databases for original reports-published between January 1982 and January 2013-on both 30- and 90-day follow-ups of unique patient populations that underwent elective primary TJA. Random-effects meta-analyses were performed to obtain pooled estimates.

Abdominal reoperation and mesh explantation following open ventral hernia repair with mesh.

Background: This study sought to identify the incidence, indications, and predictors of abdominal reoperation and mesh explantation following open ventral hernia repair with mesh (OVHR).

Methods: A retrospective cohort study of all patients at a single institution who underwent an OVHR from 2000 to 2010 was performed. Patients who required subsequent abdominal reoperation or mesh explantation were compared with those who did not.

Outcomes with porcine acellular dermal matrix versus synthetic mesh and suture in complicated open ventral hernia repair.

Background: Mesh reinforcement as part of open ventral hernia repair (OVHR) has become the standard of care. However, there is no consensus on the ideal type of mesh to use. In many clinical situations, surgeons are reluctant to use synthetic mesh.

Suture versus preperitoneal polypropylene mesh for elective umbilical hernia repairs.

Background: Repair of primary ventral hernias (PVH) such as umbilical hernias is a common surgical procedure. There is a paucity of risk-adjusted data comparing suture versus mesh repair of these hernias. We compared preperitoneal polypropylene (PP) repair versus suture repair for elective umbilical hernia repair.

Prevalence of surgical site infection at the stoma site following four skin closure techniques: a retrospective cohort study.

Background/aims: Surgical site infection (SSI) is a common complication of stoma reversal. Studies have suggested that different skin closures affect SSI rates. Our aim was to determine which skin closure technique following stoma reversal leads to the lowest rate of SSI.

Postoperative transitional care needs in the elderly: an outcome of recovery associated with worse long-term survival.

Objective: To characterize transitional care needs (TCNs) after colorectal cancer (CRC) surgery and examine their association with age and impact on overall survival (OS).

Background: TCNs after cancer surgery represent additional burden for patients and are associated with higher short-term mortality. They are not well-characterized in CRC patients, particularly in the context of a growing elderly population, and their effect on long-term survival is unknown.

Systematic review of educational interventions for ostomates.

Background: Stoma-related complications lead to increased hospital length of stay and readmissions. Although education of new ostomates is widely recommended, there is a lack of data regarding effective evidence-based educational interventions to prevent or decrease these complications.

Objective: The aim of this study was to systematically review the literature for educational interventions for new ostomates designed to decrease stoma-related complications.

Review of stoma site and midline incisional hernias after stoma reversal.

Background: The incidence of incisional hernias after stoma reversal is not well reported. The aim of this study was to systematically review the literature reporting data on incisional hernias after stoma reversal. We evaluated both the incidence of stoma site and midline incisional hernias.

Comparison of outcomes of synthetic mesh vs suture repair of elective primary ventral herniorrhaphy: a systematic review and meta-analysis.

Importance: More than 350,000 ventral hernias are repaired in the United States annually, of which 75% are primary ventral hernias (eg, umbilical or epigastric hernias). Despite the volume, there is insufficient evidence to support the use of sutures vs mesh for primary ventral hernia repairs.

Objective: To compare suture vs mesh repairs for 3 outcomes: hernia recurrence, surgical site infection (SSI), and seromas.