Pediatric Surgical Research Articles

Prevalence and Extent of Industry Funding to Program Directors Across Pediatric Surgical Specialties

IntroductionIndustry funding in surgical education offers benefits but presents conflicts of interest. This study defines the prevalence and extent of industry funding to fellowship program directors (FPDs) across pediatric surgical specialties. Materials and methodsThis was a retrospective cross-sectional analysis of FPDs in pediatric surgical specialties. Data were amalgamated from the Centers for Medicare and Medicaid Services and the Accreditation Council for Graduate Medical Education. Characteristics of FPDs were obtained from academic websites and medical licensing boards. Personal industry payments from 2016 to 2022 were analyzed, and temporal trends were elucidated. Comparisons were made by year, surgical specialty, and control groups with nonparametric tests. ResultsA total of 241 FPDs were identified, with 206 (85%) receiving industry payments over the study period. The specialties with the highest prevalence of industry funding to FPDs were pediatric orthopedic surgery (100%), pediatric urology (96%), and pediatric surgery (85%). Total industry payments aggregated to $7.3 million dollars with the majority awarded to pediatric orthopedic surgery (91%). Most industry payments were for royalties or licensing (57%) and consulting fees (31%). Median total industry payments per FPD differed between subspecialties (P < 0.001) and was highest in pediatric orthopedic surgery ($7009, interquartile range [IQR], $1771-$50,239) and lowest in pediatric otolaryngology ($116, IQR, $75-$1626). Male FPDs had higher median total industry payments than female FPDs ($1643, IQR, $172-$8731 versus $193, IQR, $84-$712, P < 0.001). ConclusionsIndustry payments to FPDs in pediatric surgical specialties are highly prevalent, but the magnitude varies by specialty. Future work is needed to establish mechanisms that promote equitable partnerships between academia and industry for pediatric surgery training.

Approaches to the Diagnosis and Management of Paediatric Ovarian Tumours and Oncological Outcomes in a Single-centre Study. Evidence in Support Of IPSO Reccomendations

BackgroundApproaches to paediatric ovarian tumours vary. Cross-sectional imaging is reliable but not always performed. Laparoscopic tumourectomy, although popular, is not recommended by International Paediatric Surgical Oncology Society (IPSO); tumour spillage remains the main concern. We aimed to investigate the reliability of preoperative evaluation and identify perioperative factors associated with adverse outcomes. MethodsSingle-centre retrospective study (2015–2022) of clinical presentation, preoperative investigation, operative approaches and oncological outcomes in all females <18 years treated for ovarian tumours. Logistic regression was used to identify predictors of malignancy and of second disease events. Data are presented as median (IQR) or rates. ResultsSixty girls aged 12.5 (10–15) years with follow-up of 51 (30.5–76.3) months were included. Incidence of malignant and low malignant potential tumours was 19/60 (32%). Tumour size and consistency proved predictive of malignancy. Clinical assessement, tumour markers and cross-sectional imaging combined showed 75% sensitivity, 100% specificity and 7% misclassified malignancy rate. Second disease events (11/60, 18%) were associated with misclassified malignancy (2/11 vs. 1/49, p = 0.04) and positive margins (4/11 vs. 5/49, p = 0.02). Ovarian-sparing surgery did not influence second events (5/11 vs. 28/49, p = 0.48). There was no significant association between second events and laparoscopic tumourectomy (3/11 vs. 20/49, p = 0.40); spillage rate was however more frequent with laparoscopy (5/11 vs. 2/32, p = 0.008). ConclusionMisclassified malignancy, noted in 7% of patients undergoing optimal work-up, adversely impacted outcomes, highlighting the importance of oncological principles in both oophorectomy and ovarian-sparing surgery. Malignancy incidence and misclassification can be underestimated when tumours with malignant behaviour potential, such as immature teratomas and borderline tumours, are grouped as benign. There was no direct association between operative approaches and second events. Laparoscopy, however, failed to maintain oncological principles more frequently than open surgery and hence risks upstaging of paediatric ovarian pathology. Level of evidenceIII.

Socio-demographic and Clinical Characteristics of Patients at Screening for an International Collaborative Free Paediatric Surgical Outreach in Sagamu, Nigeria.

Socio-demographic and Clinical Characteristics of Patients at Screening for an International Collaborative Free Paediatric Surgical Outreach in Sagamu, Nigeria.

An Enhanced Recovery Program for Pediatric, Adolescent, and Young Adult Surgical Oncology Patients Improves Outcomes After Surgery

BackgroundEnhanced Recovery after Surgery (ERAS®) is a standardized perioperative approach that utilizes a multidisciplinary team to reduce physiologic stress and improve postoperative recovery. The purpose of our study is to evaluate outcomes in pediatric, adolescent, and young adult (AYA) patients undergoing major oncologic operations before and after the implementation of an enhanced recovery program (ERP). MethodsAll patients ≤23 years old who underwent major oncologic surgery between 1/2017-2/2022 were identified. ERP was implemented on 6/7/2021, with all patients enrolling on ERP after that date. Pre-ERP patients were selected based on similar age, diagnosis, and operations. The Mann–Whitney U-test was used to compare continuous variables, and the chi-squared test or Fisher exact test as appropriate to compare categorical variables between Pre-ERP and ERP patients. ResultsA total of 47 patients were included (28 Pre-ERP, 19 ERP). The median age was 14 years (range, 1–23). 18 underwent thoracotomy, 26 laparotomy, and 3 chest wall resections. Results suggest that ERP patients had significantly shorter time to ambulation (25 h; p = 0.004) and postoperative length of stay (LOS; 3 days; p < 0.001). Two patients in the ERP group required zero narcotics after operation. ConclusionWe found initial evidence that the implementation of an ERP for pediatric, AYA patients resulted in positive postoperative outcomes – a decrease in postoperative LOS and promoted early mobility without an increase in readmission rates. Enhanced recovery programs should be incorporated into the care of pediatric, AYA oncology patients undergoing oncologic surgery. Level of EvidenceRetrospective Comparative Study – Level III.

The Story of Dr. Asa G. Yancey and Surgical Innovation in the Face of Discrimination

IntroductionDr. Asa G. Yancey published a surgical technique describing a pull – through of normal colon through a cuff of aganglionic colon to treat Hirschsprung disease in 1952, 12 y before Dr. Franco Soave whose name is attached to the procedure. Yancey and his pioneering operation went unrecognized for over half a century because of discriminatory segregation in the publishing practices of academic medicine dating back to the 1950s. Materials and methodsWe performed a literature review on the surgical therapies for Hirschsprung disease. This history was supplemented with first-hand accounts provided by Yancey's children. Further information by leaders of the American Pediatric Surgical Association Hirschsprung interest group regarding the future of surgical nomenclature for the endorectal pull-through procedure was acquired through interviews. ResultsA review of the literature revealed that Yancey's description of the pull-through technique for Hirschsprung disease was published 12 y prior to Soave's publication and yet, Yancey received little to no recognition for his work. Yancey's children describe a surgeon who was persistent in his endeavor to create a more inclusive field of academic surgery as well as a man who prioritized his family and the education of future surgeons. Conversations with the American Pediatric Surgical Association Hirschsprung interest group suggest active changes to give posthumous credit to Yancey, including renaming the procedure to the Yancey – Soave pull-through technique. ConclusionsHere, we provide a historical review of Yancey's career as well as insights on the man behind the surgery and how he persevered in academic surgery despite experiencing discrimination during the civil rights movement.

Commentary on: Environmental Impact of Traveling to the Annual American Pediatric Surgical Association Meeting

Commentary on: Environmental Impact of Traveling to the Annual American Pediatric Surgical Association Meeting

Improving outcomes for uncomplicated gastroschisis: clinical practice guidelines from the American Pediatric Surgical Association Outcomes and Evidence-based Practice Committee.

The authors sought better outcomes for uncomplicated gastroschisis through development of clinical practice guidelines. The authors and the American Pediatric Surgical Association Outcomes and Evidenced-based Practice Committee used an iterative process and chose two questions to develop clinical practice guidelines regarding (1) standardized nutrition protocols and (2) postnatal management strategies. An English language search of PubMed, MEDLINE, OVID, SCOPUS, and the Cochrane Library Database identified literature published between January 1, 1970, and December 31, 2019, with snowballing to 2022. The Appraisal of Guideline, Research and Evaluation reporting checklist was followed. Thirty-three studies were included with a Level of Evidence that ranged from 2 to 5 and recommendation Grades B-D. Nine evaluated standardized nutrition protocols and 24 examined postnatal management strategies. The adherence to gastroschisis-specific nutrition protocols promotes intestinal feeding and reduces TPN administration. The implementation of a standardized postnatal clinical management protocol is often significantly associated with shorter hospital stays, less mechanical ventilation use, and fewer infections. There is a lack of comparative studies to guide practice changes that improve uncomplicated gastroschisis outcomes. The implementation of gastroschisis-specific feeding and clinical care protocols is recommended. Feeding protocols often significantly reduce TPN administration, although the length of hospital stay may not consistently decrease.

Pediatric trauma patients with isolated grade III blunt splenic injuries may be safely managed without intensive care unit admission

BackgroundNon-operative management is the standard of care for pediatric blunt splenic injury. The American Pediatric Surgical Association recommends intensive care unit monitoring only for grade IV/V blunt splenic injury; however, variation remains regarding this practice. We hypothesized that pediatric trauma patients with near-isolated grade III blunt splenic injuries admitted to a non-intensive care unit setting would have similar outcomes to those admitted to the intensive care unit. MethodsThe 2017 to 2019 Trauma Quality Improvement Program database was queried for blunt pediatric trauma patients (≤16 years) with near-isolated grade III blunt splenic injuries. Patients with systolic blood pressure <90 mmHg or heart rate >90 were excluded. Pediatric trauma patients admitted to the intensive care unit were compared to non-intensive care unit admissions. The primary outcome was splenectomy. Bivariate analyses were performed. ResultsOf 461 pediatric trauma patients with near-isolated grade III blunt splenic injuries, 186 (40.3%) were admitted to the intensive care unit. Intensive care unit patients were older than their non-intensive care unit counterparts (15 vs 14 years, P = .03). Intensive care unit and non-intensive care unit patients had a similar rate of splenectomy (0.5% vs 0.7%, P = .80) and time to surgery (19.7 vs 19.8 hours, P = .98). Patients admitted to the intensive care unit had a longer length of stay (4 vs 3 days, P < .001). There were no significant complications or deaths in either group. ConclusionThis national analysis demonstrated that hemodynamically stable pediatric trauma patients with near-isolated grade III blunt splenic injuries admitted to the floor or intensive care unit had a similar rate of splenectomy without complications or deaths. This aligns with American Pediatric Surgical Association recommendations that pediatric trauma patients with grade III blunt splenic injuries be managed in non-intensive care unit settings. Widespread adoption is warranted and should lead to decreased healthcare expenditures.

Central Venous Catheter Consideration in Pediatric Oncology: A Systematic Review and Meta-analysis From the American Pediatric Surgical Association Cancer Committee

BackgroundTunneled central venous catheters (CVCs) are the cornerstone of modern oncologic practice. Establishing best practices for catheter management in children with cancer is essential to optimize care, but few guidelines exist to guide placement and management. Objectives: To address four questions: 1) Does catheter composition influence the incidence of complications; 2) Is there a platelet count below which catheter placement poses an increased risk of complications; 3) Is there an absolute neutrophil count (ANC) below which catheter placement poses an increased risk of complications; and 4) Are there best practices for the management of a central line associated bloodstream infection (CLABSI)? MethodsData Sources: English language articles in Ovid Medline, PubMed, Embase, Web of Science, and Cochrane Databases. Study Selection: Independently performed by 2 reviewers, disagreements resolved by a third reviewer. Data Extraction: Performed by 4 reviewers on forms designed by consensus, quality assessed by GRADE methodology. ResultsData were extracted from 110 manuscripts. There was no significant difference in fracture rate, venous thrombosis, catheter occlusion or infection by catheter composition. Thrombocytopenia with minimum thresholds of 30,000–50,000 platelets/mcl was not associated with major hematoma. Limited evidence suggests a platelet count <30,000/mcL was associated with small increased risk of hematoma. While few studies found a significant increase in CLABSI in CVCs placed in neutropenic patients with ANC<500Kcells/dl, meta-analysis suggests a small increase in this population. Catheter removal remains recommended in complicated or persistent infections. Limited evidence supports antibiotic, ethanol, or hydrochloric lock therapy in definitive catheter salvage. No high-quality data were available to answer any of the proposed questions. ConclusionsAlthough over 15,000 tunneled catheters are placed annually in North America into children with cancer, there is a paucity of evidence to guide practice, suggesting multiple opportunities to improve care. Level of EvidenceIII.This study was registered as PROSPERO 2019 CRD42019124077.

Coaching Program to Address Burnout, Well-Being, and Professional Development in Pediatric Surgery Trainees

Objective: To assess impact of participation in a positive psychology coaching program on trainee burnout and well-being. Background: Coaching using principles of positive psychology can improve well-being and reduce physician burnout. We hypothesized that participation in a coaching program would improve pediatric surgery trainee well-being. Methods: With IRB approval, a coaching program was implemented during the COVID-19 pandemic (9/2020-7/2021) in the American Pediatric Surgical Association. Volunteer pediatric surgery trainees (n=43) were randomized to receive either one-on-one quarterly virtual coaching (n=22) from a pediatric surgeon trained in coaching skills or wellness reading materials (n=21). Participants completed pre- and post-study surveys containing validated measures including PERMA (positive emotion, engagement, relationships, meaning, accomplishment), professional fulfillment, burnout, self-valuation, gratitude, coping skills, and workplace experiences. Results were analyzed using Wilcoxon rank sum test, Kruskal-Wallis test, or chi-square test. Results: Forty trainees (93%) completed both the baseline and year-end surveys and were included in the analysis. Twenty-five (64%) were female, mean age 35.7 (SD 2.3), 65% first-year fellows. Coached trainees showed an improved change in PERMA (P=0.034), burnout (P=0.024), and gratitude (P=0.03) scores from pre- to post-coaching compared to non-coached trainees. Coping skills also improved. More coaching sessions was associated with higher self-valuation scores (P=0.042), and more opportunities to reflect was associated with improved burnout and self-valuation. Conclusions: Despite the stress and challenges of medicine during COVID-19, a virtual positive psychology coaching program provided benefit in well-being and burnout to pediatric surgery trainees. Coaching should be integrated into existing wellness programs to support acquisition of coping skills that help trainees cope with the stressors they will face during their careers.

Scientific Output by Latin American Women in Pediatric Surgical Sciences Over the Past 11 Years: A Bibliometric and Visual Analysis

IntroductionThis academic article discusses the historical underrepresentation of female in science, with a focus on Latin America. It highlights the importance of both technical and non-technical skills in the medical-surgical field, particularly the role of research skills. The study aims to quantify and characterize the scientific output of Latin American female researchers over the past decade, providing insights into the challenges and opportunities in low and middle-income countries. Material and methodsA retrospective cross-sectional bibliometric study was conducted in 2023, focusing on pediatric surgical science journals in Scopus and PubMed. It assessed Latin American female participation, journal details, and interaction networks, using SPSS and Gephi software. The period analyzed was from January 2012 to December 2022. ResultsBetween 2012 and 2022, 727 articles with Latin authorship in pediatric surgery were analyzed across 304 journals. Of these, 63.69% had female co-authors. The majority were original articles (53.13%), with contributions from Brazil, Mexico, and Chile. Notable journals included the Journal of Pediatric Surgery and Child's Nervous System. Keywords like Laparoscopy and Cardiac surgery were common. A growth trend in female Latin American publications was observed, despite temporary declines. ConclusionsThis study highlights a growing trend in Latin American females' scientific contributions to pediatric surgery from 2012 to 2022, although a gender gap persists. The research mainly consists of primary data studies, with a focus on Brazil and Mexico from public institutions. The Journal of Pediatric Surgery featured prominently, and common topics included Laparoscopy, Cardiac surgery, Liver transplant, Congenital heart defects, and COVID-19. Level of EvidenceIV.

Should Pediatric Surgical Oncologists Receive Training in Vascular Surgery ? A Practice Survey Report From the International Society of Paediatric Surgical Oncology (IPSO)

BackgroundIs vascular training in paediatric surgical oncology considered desirable ? MethodsA voluntary survey of work practice was undertaken with the surgeon membership of The International Society Of Paediatric Surgical Oncology (IPSO) using a structured designed questionnaire. ResultsA total of 149 IPSO surgeon members completed the survey. 57% (N = 84) of surgeons surveyed had no specific training in vascular surgery. 43% surgeons (N = 63) stated they had acquired some skills in residency training and/or with transplantation surgery. 65% (N = 96) of respondent surgeons stated that vascular surgical training must be incorporated into pediatric surgical oncology training and 27% (N = 40) agreed that it was considered desirable. 89% (N = 133) of surgeon respondents had encountered major vascular injury during work practice while operating on pediatric solid tumors. Vascular injury repairs were undertaken and attempted by pediatric surgeons though expert assistance of vascular surgeons proved crucially essential in many instances. Emergent operations included patch repairs, vessel ligation techniques and insertion of vascular graft prostheses. Interventional radiology services to arrest life-threatening hemorrhage were also reportedly utilized by respondents. ConclusionVascular injuries have significant potential for devastating patient outcomes including never event ‘mortality’. The IPSO surgeon survey highlights that there are visible ‘gaps’ in skills training. Training to be a pediatric oncology surgeon must incorporate acquisition of skill sets proficiency in vascular surgery.

Can paediatric surgical registrars safely perform supervised hypospadias surgery?

Hypospadias repair is regarded as a technically demanding, complex procedure, with variable outcomes. Therefore, it tends to be performed by consultants, with limited trainee involvement. We aimed to study the clinical outcomes of supervised registrars performing proximal and distal hypospadias repairs, compared to their consultant mentors. We undertook a retrospective review of all primary hypospadias repairs performed between April 2013-April 2022at our tertiary paediatric urology centre. Redo repairs and patients lost to follow-up were excluded. Pre-operative anatomy, theatre time, grade of primary surgeon (registrar (trainees and non-training middle grades) or consultant), operative technique, follow-up duration, complications, and reoperation rates were recorded. The procedures were assessed in two groups according to the primary operator: registrar or consultant. The Zwisch scale is used to describe level of consultant support. Registrars as primary operators received "passive help" or "supervision" (Zwisch levels 3/4). Consultants as primary operators provided registrars with "show-and-tell" or "active help" (Zwisch levels 1/2). 270 procedures performed on 228 patients met the inclusion criteria. 109 were performed by registrars and 161 by consultants. In both groups, median age was two years (p=0.23). Median theatre time was similar (registrars 2.8 h vs. consultants 2.7 h, p=0.88), as was median follow-up (registrars 25months, vs. consultants 21months, p=0.99). Operations performed by registrars were 76% distal and 24% proximal; and by consultants were 62% distal and 38% proximal. The overall urethroplasty complication rate was similar, at 24% for registrars and 23% for consultants (p=0.89). The summary table shows the distribution of different complications. Re-operation rate was 16% in both groups (p=0.99). Complications were further assessed according to operation type (TIP vs. two-stage repair). Contrary to popular belief amongst hypospadiologists, we found complication rates were similar for registrar and consultant surgeons. We question that involvement of registrars increases complications. The literature demonstrates safety of trainee performance of limited steps of the procedure. However our institution permits registrars to perform up to the whole hypospadias repair under direct supervision, with no predefined limit to their involvement. Paediatric surgical registrars can be safely supervised to have substantial involvement in proximal and distal hypospadias repair, without compromising the duration or outcomes of surgery. We hope that allowing more registrar involvement can lead to faster acquisition of surgical skills, whilst remaining under the safety of senior supervision. Increasing opportunities for those with an aptitude for hypospadias repair can equip them with skills and confidence for entering fellowship training.

Temporal Trends of Neonatal Surgical Conditions in Texas and Accessibility to Pediatric Surgical Care

IntroductionTexas consistently accounts for approximately 10% of annual national births, the second highest of all US states. This temporal study aimed to evaluate incidences of neonatal surgical conditions across Texas and to delineate regional pediatric surgeon accessibility. MethodsThe Texas Birth Defects Registry was queried from 1999 to 2018, based on 11 well-established regions. Nine disorders (30,476 patients) were identified as being within the operative scope of pediatric surgeons: biliary atresia (BA), pyloric stenosis (PS), Hirschsprung’s disease, stenosis/atresia of large intestine/rectum/anus, stenosis/atresia of small intestine, tracheoesophageal fistula/esophageal atresia, gastroschisis, omphalocele, and congenital diaphragmatic hernia. Annual and regional incidences were compared (/10,000 births). Statewide pediatric surgeons were identified through the American Pediatric Surgical Association directory. Regional incidences of neonatal disorder per surgeon were evaluated from 2010 to 2018 as a surrogate for provider disparity. ResultsPS demonstrated the highest incidence (14.405/10,000), while BA had the lowest (0.707/10,000). Overall, incidences of PS and BA decreased significantly, while incidences of Hirschsprung’s disease and small intestine increased. Other diagnoses remained stable. Regions 2 (48.24/10,000) and 11 (47.79/10,000) had the highest incidence of neonatal conditions; Region 6 had the lowest (34.68/10,000). Three rural regions (#2, 4, 9) lacked pediatric surgeons from 2010 to 2018. Of regions with at least one surgeon, historically underserved regions (#10, 11) along the Texas–Mexico border consistently had the highest defect per surgeon rates. ConclusionsThere are temporal and regional differences in incidences of neonatal conditions treated by pediatric surgeons across Texas. Improving access to neonatal care is a complex issue that necessitates collaborative efforts between state legislatures, health systems, and providers.

PT47 High-Volume Hospitals Experience Fewer Postoperative Complications After Neonatal Surgery: Analyses of the National Clinical Database Pediatric Surgical Registry in Japan

PT47 High-Volume Hospitals Experience Fewer Postoperative Complications After Neonatal Surgery: Analyses of the National Clinical Database Pediatric Surgical Registry in Japan

Comparing Pediatric Surgeons' and Palliative Care Pediatricians’ Palliative Care Practices and Perspectives in Pediatric Surgical Patients

PurposeThe nature of interactions between surgical and pediatric palliative care (PPC) teams caring for seriously ill children is unknown. This study compares pediatric surgeons' and PPC physicians’ perspectives and practices regarding PPC in surgical patients. MethodsA survey was administered to members of the American Pediatric Surgical Association and Pediatric Interest Group of the American Academy of Hospice and Palliative Medicine. ResultsOne hundred twenty-four pediatric surgeons (31% female, 17.2 mean years of experience) and 71 PPC physicians (69% female, 10.1 mean years of experience) participated. Forty-three percent of surgeons reported consulting PPC often for children with serious illnesses. However, most PPC physicians (67%), said they are rarely/never consulted by surgeons (p = 0.002). PPC physicians were more likely to report that PPC involvement was too late (43% vs 21%, p = 0.005). More surgeons than PPC physicians felt that an appropriate time for PPC consultation was during serious illness deterioration (30% vs 7%, p = 0.05), whereas PPC physicians preferred consultation at diagnosis (54% vs 34%, p = 0.05). More PPC physicians (67%) than surgeons (17%) agreed that invasive interventions could be considered a form of PPC (p = 0.002). The most reported barrier to PPC consultation by surgeons (29%) was concern that parents would think the surgical team was giving up. PPC physicians were more likely to perceive barriers to consultation by surgeons than surgeons themselves (p < 0.001). ConclusionWhile pediatric surgeons value PPC involvement, surgical culture and misperception of parental resistance to PPC involvement lead to palliative care consultation only when illness acuity and severity are high, the possibility of curability is low, and death seems imminent. Seeking to understand patient and family priorities in care, managing patient and parental psychological distress, and treating non-surgical symptoms are areas where PPC can improve patient care. Barriers to PPC use and self-reported knowledge gaps in PPC provision may be mitigated by formalized PPC training for surgeons and intentional collaboration between the two groups. Type of StudySurvey. Level of EvidenceN/A.

WTP7.12 Investigating the duration of empirical antibiotic treatment and subsequent reduction in hospital readmission rates for perforated appendicitis in the paediatric patient population

Abstract Background and Aim Acute appendicitis is the most common surgical emergency in the paediatrics. Complicated appendicitis often involves perforation, requiring a longer course of antibiotics post-appendicectomy [1]. There is considerable variability on post-operative antibiotic regimes and duration within hospital trusts with no national guidelines. Local Trust-based consensus [2] recommends a 5-day course IV co-amoxiclav with American Paediatric Surgical Association guidelines suggesting oral conversion if IV antibiotic duration is less than 5 days [3, 4]. Therefore, we measured compliance with local and international guidelines. Methods Paediatric patients aged 5-17 years were selected for the study using ICD-10 codes for ‘Perforated Appendicitis’ (K35.2 and K35.3). Patients were included if they had operative management for perforated appendicitis between 1 April 2021 and 31 March 2022. Key parameters collated included; re-admission, duration of re-admission, complication, post-operative antibiotic use (selection, intravenous/oral dose and duration of use). Results Twenty-six paediatric appendicectomies for perforated appendicitis occurred within the time frame. Nine had IV antibiotics for &amp;gt;5 days, of this cohort, 7 had oral conversion and completed 2-5 days of oral antibiotics with re-admission rate 33%. Eleven had IV antibiotics for &amp;lt; 5 days with oral conversion for 4-7 days, readmission rate was 18.2% on days 4 &amp; 5 respectively. Six had IV antibiotics for &amp;lt;5 days with no oral conversion and no patients were re-admitted. Conclusions A longer duration of antibiotics with an earlier conversion from IV to oral, reduced readmission rates. However, greater research with more participants and standardised antibiotics can explore other influencing factors.

Unilateral MCKD in Children: Experience from a Tertiary Care Paediatric Surgical Centre

Unilateral MCKD in Children: Experience from a Tertiary Care Paediatric Surgical Centre

Pediatric Surgeon Perceptions on Operating Room Environmental Stewardship and Current Institutional Climate-Smart Actions

BackgroundOperating rooms generate significant greenhouse gas emissions. Our objective was to assess current institutional climate-smart actions and pediatric surgeon perceptions regarding environmental stewardship efforts in the operating room. MethodsA survey was distributed to members of the American Pediatric Surgical Association in June 2022. The survey was piloted among ten general surgery residents and two professional society cohorts of pediatric surgeons. Comparisons were made by demographic and practice characteristics. ResultsSurvey response rate was 15.9% (n = 160/1009) and included surgeons predominantly from urban (n = 93/122, 76.2%) and academic (n = 84/122, 68.9%) institutions. Only 9.8% (n = 12/122) of pediatric surgeons were currently involved in operating room environmental initiatives. The most common climate-smart actions were reusable materials and equipment (n = 120/159, 75.5%) and reprocessing of medical devices (n = 111/160, 69.4%). Most surgeons either strongly agreed (n = 48/121, 39.7%) or agreed (n = 62/121, 51.2%) that incorporation of environmental stewardship practices at work was important. Surgeons identified reusable materials/equipment (extremely important: n = 61/129, 47.3%, important: n = 38/129, 29.5%) and recycling (extremely important: n = 68/129, 52.7%, important: n = 29/129, 22.5%) as the most important climate-smart actions. Commonly perceived barriers were financial (extremely likely: n = 47/123, 38.2%, likely: n = 50/123, 40.7%) and staff resistance to change (extremely likely: n = 29/123, 23.6%, likely: n = 60/123, 48.8%). Regional differences included low adoption of energy efficiency strategies among respondents from southern states (n = 0/26, p = 0.01) despite high perceived importance relative to other regions (median: 5, IQR: 4–5 vs median: 4, IQR 4–5, p = 0.04). ConclusionsWhile most pediatric surgeons agreed that environmental stewardship was important, less than 10% are currently involved in initiatives at their institutions. Opportunities exist for surgical leadership surrounding implementation of climate-smart actions. Level of EvidenceLevel III.

Attitudes Toward Surgical Innovation Research in the Pediatric Surgery Fellowship Match

IntroductionPediatric surgery applicants are increasingly pursuing research in non-traditional fields including surgical innovation. This study aims to evaluate the relative value that pediatric surgeons involved in fellow selection place on innovation experience compared to traditional research. MethodsA cross-sectional web-based survey of American Pediatric Surgical Association members involved in the selection of pediatric surgical fellows was conducted. Respondents reported their own innovation experience and were asked to identify valuable traits of applicants who completed an innovation fellowship. They rated the value of traditional research metrics including publications, presentations, and advanced degrees compared to patents and other innovation-related metrics. Comparisons were made between those with and without innovation experience with respect to gender, years in practice, and institutional role. ResultsOne hundred thirty respondents were involved in pediatric surgery fellow selection. Innovation work was felt to be equal to or more valuable than basic science by 75% of respondents (84% vs. clinical/outcomes, 93% vs. other non-traditional, 72% vs. other clinical fellowships). Commonly cited concerns included “fewer publications” (21%) and “preoccupation with financial reward” (19%). The most valuable innovation-related metrics were “developing a novel surgical procedure” (67%) and “developing a novel device” (58%). When asked if the respondent would advise a junior resident to pursue an innovation fellowship, 49% would, 9% would not, and 43% were unsure. Seventeen percent expressed concern for match success. ConclusionInnovation experience is generally viewed positively by pediatric surgeons involved in fellow selection. However, applicants and mentors would benefit from focusing on traditional academic outputs to ensure competitiveness. Type of StudyCross-sectional observational study. Level of EvidenceIII.