Publications by authors named "Sarah Cairo"
Background: There is no consensus on the appropriate duration of postoperative antibiotics for complicated appendicitis in children. Commonly used antibiotic endpoints include normalization of white blood cell count (WBC) or completion of a minimum number of prespecified treatment days. We compared clinical outcomes resulting from varying postoperative antibiotic protocols for complicated appendicitis in children.
View Article and Find Full Text PDFImportance: Conclusions vary substantially among studies examining associations between area-based social determinants of health (SDOH) and pediatric health disparities based on the selected patient population and SDOH index. Most national studies use zip codes, which encompass a wide distribution of communities, limiting the generalizability of findings.
Objectives: To characterize the distributions of composite SDOH indices for pediatric surgical patients within a national sample of academic children's hospitals and to assess SDOH index precision in classifying patients at similar levels of disadvantage.
Purpose: This study describes the experience with common neonatal surgical conditions and their outcomes at a single center in the Eastern Democratic Republic of the Congo (DRC) over a period of 7 years (2016-2022).
Methods: A retrospective review of neonatal surgical admissions and their outcomes was performed for patient admitted between January 2016 and December 2022 at HEAL Africa teaching hospital. Data were collected from the neonatal admission and discharge registry for all patients with a potential surgical condition.
Purpose: Pediatric surgical care in low- and middle-income countries is often hindered by systemic gaps in healthcare resources, infrastructure, training, and organization. This study aims to develop and validate the Global Assessment of Pediatric Surgery (GAPS) to appraise pediatric surgical capacity and discriminate between levels of care across diverse healthcare settings.
Methods: The GAPS Version 1 was constructed through a synthesis of existing assessment tools and expert panel consultation.
Article Synopsis
- Hemorrhage is a leading cause of preventable death in injured children, requiring effective monitoring of hemoglobin (Hb) levels without the stress of multiple blood draws; the Rainbow-7 device offers a noninvasive solution for continuous Hb measurement.
- The study involved a group of 39 pediatric patients with solid organ injuries and compared noninvasive Hb readings with traditional blood tests; results showed a significant correlation between both methods, indicating the potential usefulness of noninvasive monitoring.
- Despite some differences in readings influenced by factors like anemia and race, the findings support the idea that noninvasive Hb monitoring could be a valuable tool in managing pediatric trauma patients effectively.
Article Synopsis
- Anterior abdominal wall defects are uncommon and can impact several organ systems, including the gastrointestinal, genitourinary, musculoskeletal, and neurospinal areas.
- The complexity of the anatomy in these patients requires meticulous surgical planning for successful reconstruction.
- The case highlights a unique female patient with anorectal malformation and musculoskeletal/genital issues similar to classic bladder exstrophy, despite minimal involvement of the urinary bladder, sphincter, and urethra.
Article Synopsis
- IVC thrombus is a rare but serious complication linked to abdominal tumors in children, affecting treatment choices and outcomes.
- The study reviewed 14 pediatric patients with IVC thrombus associated with various abdominal malignancies and examined imaging, surgical interventions, and outcomes from 2006 to 2017.
- Most patients underwent surgery, with many receiving neoadjuvant chemotherapy, and there were no reported deaths, though some complications occurred post-surgery.
Article Synopsis
- Ewing sarcoma is a cancer often found in adolescents that requires combined treatment approaches, including surgery and radiation therapy, but there's limited research comparing their effectiveness.
- A study analyzed data from 61 patients treated at a pediatric hospital between 2010 and 2020, focusing on patient demographics, treatment responses, and survival outcomes over 5 years.
- Results showed no significant difference in local failure-free survival, event-free survival, or overall survival between patients treated with radiation alone and those who underwent surgery plus radiation, indicating that both treatment options are similarly effective.
Background: Several studies have reported decreased trauma admissions and increased physical abuse in children resulting from stay-at-home measures. However, these studies have focused on a limited period after the implementation of lockdown policies. The purpose of this study was to examine the effect of quarantine and reopening initiatives on admissions for varying types of injuries in pediatric patients.
View Article and Find Full Text PDFBackground: 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.
Article Synopsis
- Unintentional window falls are a significant but preventable cause of injury and death in children, despite ongoing safety campaigns.
- The study analyzed emergency department visits and trauma registries from children's hospitals to assess the frequency and patterns of these falls.
- Findings indicated that most incidents involved children under 6 years old, primarily occurring from second-story windows in smaller cities, suggesting a need for targeted safety interventions and increased awareness.
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.
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.
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).
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.
Article Synopsis
- Pilonidal disease (PD) commonly affects adolescents and can be challenging to manage; the study investigates the use of porcine bladder extracellular matrix (PBEM) as a treatment method.
- In a review of 52 PD wounds treated with PBEM from 2012 to 2016, 78% achieved complete healing within two months, with high patient satisfaction reported.
- Future studies are planned to further compare PBEM with other wound care methods to enhance understanding of healing times and treatment effectiveness for PD.
Introduction: Biliary dyskinesia (BD) is a common indication for pediatric cholecystectomy. While diagnosis is primarily based on diminished gallbladder ejection fraction (GB-EF), work-up and management in pediatrics is controversial.
Methods: We conducted a multi-institutional retrospective review of children undergoing cholecystectomy for BD to compare perioperative work-up and outcomes.
Article Synopsis
- Overuse of prescription opioids in both adults and children has raised concerns, prompting the need for educational interventions to potentially reduce opioid prescriptions in pediatric patients after surgeries.
- A study was conducted comparing opioid prescriptions before and after implementing staff education and standardized protocols for managing pain in patients under 19 years following appendectomies, revealing a drastic drop in opioid prescriptions from 84.3% to 6.7% post-intervention.
- Results showed that non-opioid pain management methods were effectively used, leading to high patient satisfaction and adequate pain control without an increase in emergency visits or complaints, indicating that educational strategies can successfully limit opioid use in pediatric post-operative care.
Purpose: To examine postoperative length of stay (LOS), hospital readmission, and 30-day complications in pediatric patients undergoing laparoscopic ileocecal resection in a contemporary cohort.
Methods: Retrospective review of the American College of Surgeons National Surgery Quality Improvement Project, Pediatric (NSQIP-P) 2012-2016 participant user files for patients <19 years old who underwent laparoscopic ileocecal resection. Mean postoperative LOS, hospital readmission and both wound-specific and composite complications were calculated and compared by year of operation.
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.
Background: Patients with gastroschisis and prolonged total (or partial) parenteral nutrition (PN) commonly develop direct hyperbilirubinemia (DH).
Objective: To quantify the prevalence and severity of DH in newborns with gastroschisis and characterize the diagnostic work-up for DH in this patient population.
Design/methods: Retrospective chart review of patients born with gastroschisis between 2005 and 2015 for the first 6 months of life.
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.
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.
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.