Pediatric Urologic Surgery Research Articles

Simulation Models for Training in Pediatric General, Thoracic, Plastic, and Urologic Surgery in Low-resource Settings: A Scoping Review.

Simulation is an educational tool that can be used to augment surgical training. We sought to provide an overview of existing pediatric surgical simulation models, with a focus on low-cost models amenable for use in low-resource settings. PubMed and Google Patents were searched for studies describing simulation models for pediatric surgery. Studies were included if cost, construct validity, face validity, or reproducibility were described, and if the model was either already utilized in low-resource settings or amenable for use in low-resource settings. A total of 18 studies and 7 patents were included. Over half (58.3%) of the models were created in the last five years. Only four models were created in an upper-middle income country, and none were created in a low or lower-income middle income country (LMIC) (16.7%). Most models were designed for general pediatric surgical procedures, with esophageal atresia repair being the most common procedure (20.8%). The cost of models ranged between $0.61 USD to $301.44 USD, and cost per simulation episode ranged from $0.61 to $38 USD. Seven models (41.1%) were 3D printed. Thirteen models (54.2%) were simulators for minimally-invasive procedures. Sixteen models (66.7%) were deemed to be reproducible based on their descriptions in published manuscripts or available patents. The utilization of simulation models in pediatric surgery is growing. Unfortunately, there are few validated models that can be used for training in low-resource settings. Significant work remains to be done on developing educational simulation tools for pediatric surgery in low-resource settings.

Reply to Editorial Comment on"Patient and Provider Education Safely Reduces Opioid Prescribing After Pediatric Urologic Surgery".

Reply to Editorial Comment on"Patient and Provider Education Safely Reduces Opioid Prescribing After Pediatric Urologic Surgery".

The influence of positive and negative intraoperative feedback in laparoscopic simulation in pediatric urology training.

This study aimed to explore the impact of positive or negative feedback on the performance of trainees in pediatric urology during simulation exercises in pediatric laparoscopy. Twenty-five students enrolled in a national Pediatric Urology Laparoscopy Simulation participated in the study. They performed the Fundamentals of Laparoscopic Surgery (FLS) skills, specifically peg-transfer and intracorporeal knot-tying, in a randomized study design while receiving positive or negative feedback from an attending pediatric urologist. On the first day, all students performed FLS peg-transfer and intracorporeal knot-tying tasks on a pediatric laparoscopic simulator. On the second day, students were randomized to receive either positive or negative comments during the procedure. Task performances, measured by task time and errors, was compared between both groups. Statistical analysis was conducted using the Mann-Whitney U test. The difference in execution time between exercises with and without feedback was significantly greater in the group that received negative feedback compared to the group that received positive feedback (p=0.003). Students who received positive feedback increased their time by a median of 2s, whereas students who received negative comments increased their time by a median of 34s. Feedback should be delivered in a manner that is supportive, respectful, and improvement-focused rather than discouragement. Understanding these dynamics can guide the development of effective feedback strategies to optimize learning and enhance performance outcomes in training for minimally invasive surgery in pediatric urology.

Effectiveness of Ultrasound-Guided Regional Anaesthesia in Paediatric Patients Undergoing Urological Surgeries: A Systematic Review

Recent research in anatomy and ultrasound has highlighted the importance of a technique named ultrasound-guided regional anaesthesia in pediatric anaesthesia, due to its approach to enhancing nerve visualization and targeted nerve blockade which improves patients’ safety and pain relief during surgical procedures. Objectives: To evaluate the outcomes of pediatric patients who received ultrasound-guided regional anaesthesia during urological surgeries and compare its effectiveness in pain control, anaesthetic quality, and post-surgery results. Methods: A search was conducted according to PRISMA guidelines using PubMed, Google Scholar, Springer Link, and Science Direct. A total of 96 studies were included after applying the inclusion criteria to articles published between January 2013 and April 2024. Out of these, only 15 were used in the study table to highlight the effectiveness of ultrasound-guided regional anaesthesia in pediatric urological surgeries. Results: Consistently, the alignment with the ultrasound-guided regional anaesthesia revealed significantly greater analgesic efficacy, least opioid usage as well and lesser rates of anaesthesia-related adverse events in pediatric subjects mainly neurodevelopmental concerns and opioid dependency. Other papers also revealed better hemodynamic control and the duration of time needed to feel fully recovered postoperatively, and thus, ultrasound-guided regional anesthesia may enhance perioperative outcomes and ambience in children undergoing different urological procedures. Conclusions: It was concluded that ultrasound-guided regional anaesthesia appears to be applicable for pediatric urological surgery, providing better analgesia, fewer side effects, and reduced demand for systemic anaesthesia. Future studies should establish the long-term results of the method and make comparisons to the other procedures

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

Industry 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. This 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. A 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). Industry 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.

Patient and Provider Education Safely Reduces Opioid Prescribing After Pediatric Urologic Surgery

To examine current opioid prescribing and determine what clinical factors were associated with use of opioids after urologic surgery after a previous study from our institution found that education regarding opioid prescribing practices significantly decreased post-operative opioid prescriptions from 61% to 34% (P<.0001). From 2017 to 2023, a questionnaire querying what medications were used for post-operative pain was administered to patients/families at a postoperative visit. Survey results and demographic factors were obtained via retrospective chart review. Fisher's exact and t tests compared patients who did and did not use opioids. 1630 patients' families completed a survey, with mean age 5.3 years, 95% male. Over the study period, 550 patients (34%) were prescribed opioids, and 474/1630 (29%) used opioids post-operatively. Patients who used opioids were significantly older (7 vs 4 years, P<.0001). Endoscopic surgery (P=.0005), buried penis/torsion/chordee repair (P<.0001), meatoplasty/skin bridge (P<.0001), and alternating acetaminophen and ibuprofen (P<.0001) were associated with decreased opioid use. Families of patients who used opioids had higher rates of calling the clinic (6% vs 2%, P=.0011) and visiting the Emergency Department (ED) with pain concerns (3% vs 0.7%, P=.002). In 2017, 63% of patients were prescribed opioids after surgery compared with 6% in 2023 (P<.0001). Most pediatric urologic surgeries can be performed without outpatient post-operative opioids. After education, we decreased opioid prescribing to only 5% of patients. The patients who were prescribed opioids had higher rates of ED visits or calling the clinic nurses with pain concerns.

Artificial Intelligence Tools in Pediatric Urology: A Comprehensive Review of Recent Advances.

Artificial intelligence (AI) is providing novel answers to long-standing clinical problems, and it is quickly changing pediatric urology. This thorough analysis focuses on current developments in AI technologies that improve pediatric urology diagnosis, treatment planning, and surgery results. Deep learning algorithms help detect problems with previously unheard-of precision in disorders including hydronephrosis, pyeloplasty, and vesicoureteral reflux, where AI-powered prediction models have demonstrated promising outcomes in boosting diagnostic accuracy. AI-enhanced image processing methods have significantly improved the quality and interpretation of medical images. Examples of these methods are deep-learning-based segmentation and contrast limited adaptive histogram equalization (CLAHE). These methods guarantee higher precision in the identification and classification of pediatric urological disorders, and AI-driven ground truth construction approaches aid in the standardization of and improvement in training data, resulting in more resilient and consistent segmentation models. AI is being used for surgical support as well. AI-assisted navigation devices help with difficult operations like pyeloplasty by decreasing complications and increasing surgical accuracy. AI also helps with long-term patient monitoring, predictive analytics, and customized treatment strategies, all of which improve results for younger patients. However, there are practical, ethical, and legal issues with AI integration in pediatric urology that need to be carefully navigated. To close knowledge gaps, more investigation is required, especially in the areas of AI-driven surgical methods and standardized ground truth datasets for pediatric radiologic image segmentation. In the end, AI has the potential to completely transform pediatric urology by enhancing patient care, increasing the effectiveness of treatments, and spurring more advancements in this exciting area.

Intraoperative ultrasound-guided paediatric urological surgery: a pictorial review.

Intraoperative ultrasound is described widely in multiple pathological scenarios in adult practice and in image-guided interventions in children. We aim to describe the technique and range of potential uses of intraoperative ultrasound in paediatric urological surgery, from outlining the process of case selection, preparation, and logistics to demonstrating the ranging benefits of real-time, high spatial resolution ultrasound during resection. At our centre, we use intraoperative ultrasound to assist in a variety of operations. These include guiding excision margins in nephron-sparing surgery, assessing for vascular infiltration in renal tumours, and identifying salvageable testicular tissue in orchidectomy. By exhibiting these scenarios, we hope to display the unique value that intraoperative ultrasound can have to the paediatric surgeon and inspire additional uses further afield.

A Double-blinded Randomized Controlled Trial Assessing the Efficacy of Opioid Disposal Instructions with Parental Education on Proper Opioid Disposal Rates Following Ambulatory Pediatric Urologic Surgery

To determine if the administration of standardized opioid disposal instructions with focused parental education improves proper disposal of leftover opioid medication among families of children undergoing ambulatory urologic surgery compared to routine postoperative instructions. A prospective, double-blinded, single-center randomized controlled trial was conducted in children 6-18 years undergoing ambulatory urology procedures between October 2021 and April 2023. Patients were randomized (1:1) to receive either the Food and Drug Administration (FDA) opioid disposal best practices worksheet plus nursing parental education or routine postoperative instructions alone. All patients were prescribed acetaminophen and ibuprofen and a per-protocol rescue opioid prescription. The primary outcome was rate of proper opioid disposal at 10-14 days post-procedure. Secondary outcomes included parents' postoperative pain measure (PPPM) scores, numerical pain scale (NPS) scores, and weight-based opioid utilization at 48hours and 10-14 days. We randomized 104 participants (53 intervention, 51 control) with 97% (101/104) complete follow-up data at 10-14 days. Patient demographics, procedural characteristics, and analgesia use were similar between groups. We observed no significant difference in proper opioid disposal rates between arms (31% intervention vs18% control; estimated difference in proportion 13% [95% CI, -4%-29%]; P=.1). There were no increased odds of proper disposal of leftover opioid medication at 10-14 days with the intervention compared to the control (OR 2.0 [95% CI 0.8-5.1]; P=.1). We observed no differences in PPPM scores, NPS scores, or opioid utilization at 48hours or 10-14 days. Providing formal opioid disposal instructions with parental education did not improve proper disposal of leftover opioid medication nor did it alter post-discharge opioid utilization after pediatric urologic surgery.

Robotic Pediatric Urologic Surgery-Clinical Anesthetic Considerations: A Comprehensive Review.

Minimally invasive robotic approaches have become standard in many institutions over the last decade for various pediatric urological procedures. The anesthetic considerations for common laparoscopic and robotic-assisted surgeries are similar since both require the insufflation of CO2 to adequately visualize the operative area. However, few studies exist regarding anesthesia for robotic procedures in children. We hypothesized that pediatric patients undergoing robotic urologic surgeries would require specific anesthetic strategies, especially given the inherently longer durations of these procedures. This study aimed to evaluate anesthetic considerations, current robotic procedures, optimal patient positioning, and port placement for robotic-assisted surgery in pediatric patients. A comprehensive literature review of all published manuscripts from PubMed, EMBASE database, and Google Scholar was performed, focusing on robotic procedures involving pediatric patients, anesthesia for pediatric urology patients, and related topics from 1996 to 2023. Forty published manuscripts were identified and reviewed in depth. In pediatric cases, insufflation pressures and volumes are lower due to the laxity of the abdominal wall. However, the increase in intra-abdominal pressure and absorption of CO2 may result in disproportionate changes in cardiopulmonary function. Specific patient positioning for robotic approaches may further compound these physiological changes. Correct patient positioning is essential to facilitate surgery optimally and safely. Understanding the physiological changes that can occur during a pediatric patient's robotic urologic surgery allows for safer anesthesia management.

Application of the ERAS guidelines in pediatric urological surgery: a systematic review.

Consensus for Enhanced Recovery After Surgery (ERAS) in pediatrics has been achieved in neonatal intestinal surgery, yet it is not widely utilized in pediatric urology. We investigated the application of ERAS guidelines in pediatric urology, and determined its effects given the available level of evidence supporting the ERAS protocol in children. A systematic literature review including series providing adoption of fast-track recovery protocols for pediatric urology procedures was carried out. Main outcome measures were study characteristics, adherence to the 19 ERAS items, complication rates and length of hospital stay. Sub-group analysis by surgery type (hypospadias versus major surgery) was performed. Nine series with data from 1272 surgical pediatric cases were included. An enhanced recovery pathway was applied in 67.3% of the reports. Two series included patients undergoing hypospadias repair and ERAS items were insufficiently reported. Studies including children undergoing major procedures mentioned a median of 15 ERAS items, yet applied a median of 11 items. Median compliance rate was 88.9% (range 50-100). More ERAS guideline items were reported (applied or mentioned) in the most recently published studies. There is limited reporting and use of the ERAS guidelines in urologic surgery particularly in hypospadias repair; whilst in major surgery in children, adherence and compliance rates vary widely. In more recent series there was an increase in ERAS items that have been mentioned and applied. Future research is needed to identify barriers and to overcome them in order to fully adopt and benefit from the ERAS pathway.

Renal function in pediatric urologic surgical patients: Insight from the National Surgical Quality Improvement Program—Pediatric cohort

Abstract Background Renal protection is a frequent indication for urological surgery in pediatric patients; however, preoperative assessment is not routinely performed. We assessed the rates of preoperative renal function testing and stratified outcomes after major pediatric urological surgery. Pediatric urology patients, specifically high-risk patients undergoing genitourinary surgeries, are likely to have an underdiagnosis of renal dysfunction after surgery. Materials and methods Cases were identified from the 2012 to 2019 National Surgical Quality Improvement Program—Pediatric database. Patients who underwent major urological surgery on an inpatient basis were included in this study. Abnormal renal function was defined as a creatinine (Cr) level of ≥0.5 mg/dL (younger than 2 years) and a glomerular filtration rate of &lt;90 mL/min (2 years or older). Glomerular filtration rate was calculated using the bedside Schwartz equation (2 years or older): estimated glomerular filtration rate = 0.413 × (height/Cr). Results A total of 17,315 patients were included, of whom 3792 (21.9%) had documented Cr values. Based on the defined criteria, abnormal renal function was found in 7.3% of infants (younger than 2 years), 33.6% of children (2–9 years), and 52.5% of adolescents (10–18 years). Patients with abnormal preoperative renal function values were significantly (p &lt; 0.001) more likely to experience readmission (10.2% vs. 5.8%), reoperation (3.7% vs. 1.6%), surgical organ/space infection (0.9% vs. 0.4%), transfusion (1.5% vs. 0.6%), renal insufficiency (1.6% vs. 0.4%), or urinary tract infection (5.1% vs. 3.6%). Conclusions In this pediatric population, 21.9% of the patients had documented preoperative Cr values before major urological surgery. Patients with documented abnormal preoperative renal function tests experienced higher complication rates. These patients have higher rates of progressive renal insufficiency and acute renal failure than those with normal renal function. The introduction of a standardized and unbiased risk assessment tool has the potential to offer patients benefits by pinpointing individuals with a heightened risk of complications. Further investigation is necessary to enhance the precise categorization of at-risk patients.

Opioid prescription usage and disposal after provider education and SMS-based parent education

Adequate pain control after outpatient pediatric urologic surgery is important for both providers and caregivers; however, opioid pain medications are often prescribed in excess of utilization. The resultant excess opioid medication has potential to be diverted or misused. While families are instructed to dispose of leftover opioids, a significant proportion may not dispose of leftover medication. We performed a quality improvement (QI) initiative within a tertiary academic care center to examine opioid excess, opioid disposal, and whether a two-component QI intervention of provider education and family education via automated SMS messages on opioid disposal could improve excess opioid prescribing and leftover opioid disposal. Prospective parent surveys were performed on a baseline cohort of 73 patients undergoing outpatient pediatric urologic surgery between July 27 and September 4, 2020. Based on baseline data, a two-component quality improvement initiative was implemented. The first component was non-binding surgeon education regarding opioid prescribing versus opioid utilization. The second component was initiation of automated SMS messages to families after surgery with information on expected postoperative course and hyperlinked instructions for opioid disposal with GPS search for opioid disposal sites nearby. We then repeated the survey for a second cohort of patients between September 14 and October 29, 2021, including additional questions regarding SMS message utility. Of 73 patients in the baseline group, 46% were prescribed opioids (Summary Table). Of patients prescribed opioids, a median of 3 doses were used and 96% had leftover opioid medication. Seventeen percent of parents in the baseline group disposed of unused opioids prior to survey completion (1-4 weeks postop). After the intervention, 19 of 74 (26%) patients were prescribed opioids. In the group that received opioids, a median of 2 doses were used and 63% reported disposing of opioids. Ninety-six percent of parents reported satisfaction with SMS messages. Many competing priorities exist for surgical providers and parents of children undergoing outpatient pediatric urologic surgery. A passive program that delivers just-in-time information in the postoperative period has high utility for both parents and providers. Automated SMS messages and provider education about opioid utilization are associated with decreased excess opioid after outpatient pediatric urologic surgery and improved opioid disposal rates by parents. These interventions are easily implemented without significant manpower and should be considered by organizations interested in decreasing excess community opioids after outpatient pediatric urologic surgery.

РОБОТ-АССИСТИРОВАННАЯ ХИРУРГИЯ В ДЕТСКОЙ УРОЛОГИИ - ПЕРВЫЙ ОПЫТ

Robot-assisted surgery in pediatric urology is developing most intensively among other surgical disciplines in the direction from simple to complex reconstructive interventions. The purpose of the Article is to summarize the current state of the problem of robotic surgery in pediatric urology and evaluate its future possibilities. The scientific study was carried out at the Irkutsk Oblast Regional Children's Clinical Hospital (Irkutsk, Russia) in Dec. 2022-May 2023. 19 robot-assisted procedures were performed over the entire period. Robotic surgeries were performed using the new Versius robotic platform by Cambridge Medical Robotics (UK). All surgical procedures were performed according to the same principles as well as the pattern Authors have previously adopted from the very beginning of their own experience with the Versius system. In all cases, three robotic ports were used: a single 12 mm trocar for optics (openly inserted at the level of the umbilicus) and two 5 mm trocars for robotic manipulators. Additionally, a 5-mm laparoport was installed for the assistant to work during the robotic operation. The study recorded patients' perioperative parameters related to demographics, surgical details and both early- and long-term outcomes. Results: 19 patients were included in the study (11 (58 [34; 80]%) boys/8 (42 [20; 66]%) girls) with the age the surgery was performed in 10.4±4.2 years old (median - 10.0 [7.0; 14.5] y/o) and the weight at the surgery 41.0±16.2 kg (median - 41.0 [27.0; 54.3] kg). Robot-assisted operations in pediatric urology were represented by the following procedures: pyeloplasty in 6 (32 [13; 57]%); removal of a kidney cyst in 5 (26 [9; 51]%); nephrectomy in 4 (21 [6; 46]%); Hellström-Chapman in 1 (5 [0; 26]%) and resection of the bladder diverticulum in 1 (5 [0; 26]%) patient. The mean duration of surgical intervention was 142.2±49.7 min (median - 140.0 [110.0; 160.0] min). Interventions were not accompanied by intraoperative complications. No significant complications were noted in both early and late postoperative periods. Conclusion: initial experience with robotic-assisted surgery confirmed that robotics can be safely and effectively used in children with urological pathology.

Effectiveness of perioperative low-dose esketamine infusion for postoperative pain management in pediatric urological surgery: a prospective clinical trial

BackgroundPostoperative pain is common in pediatric urological surgery. The study assess the impact of perioperative intravenous infusion of low-dose esketamine on postoperative pain in pediatric urological surgery.MethodsPediatric patients (n = 80) undergoing urological surgery were randomized into four groups. Patients in the control group were administered an analgesic pump containing only hydromorphone at a dose of 0.1 mg/kg (Hydromorphone Group 1, H1) or 0.15 mg/kg (Hydromorphone Group 2, H2). Patients in the experimental group were injected intravenously with 0.3 mg/kg of esketamine (Esketamine group 1, ES1) or equal volume of saline (Esketamine Group 2, ES2) during anesthesia induction. Esketamine 1.0 mg/kg and hydromorphone 0.1 mg/kg were added to the analgesic pump. Face, Leg, Activity, Crying, and Comfort (FLACC) scale or the Numerical Rating Scale (NRS) and adverse effects were recorded at 2, 6, 24, and 48 h postoperatively. Additionally, total and effective PCA button presses were recorded.ResultsIn comparison to the H1 group, the pain scores were notably reduced at all postoperative time points in both the ES1 and H2 groups. The ES2 group exhibited lower pain scores only at 24 and 48 h postoperatively. When compared to the H2 group, there were no significant differences in pain scores at various postoperative time points in the ES2 group. However, the ES1 group demonstrated significantly lower pain scores at 6, 24 and 48 h postoperatively, and these scores were also significantly lower than those observed in the ES2 group. The total and effective number of PCA button presses in the ES1, ES2 and H2 group were lower than that in the H1 group (P < 0.001). The incidence of adverse effects within 48 h after surgery was 15% in ES1, 22% in ES2, 58% in H1, and 42% in H2, respectively (P = 0.021).ConclusionsThe use of low-dose esketamine infusion in analgesia pump can effectively alleviates postoperative pain in pediatric urological patients, leading to a significant reduction in the number of analgesic pump button press. The combined approach of perioperative anesthesia induction and analgesia pump administration is recommended for optimal pain management in these patients.Trial registrationChinese Clinical Trial Registry- ChiCTR2300073879 (24/07/2023).

Robotic Surgery in Pediatric Urology

Robotic Surgery in Pediatric Urology

Regional Anesthesia for Pediatric Urologic Surgery – What’s New?

Regional Anesthesia for Pediatric Urologic Surgery – What’s New?

Utility of Postoperative Phone Calls in Reducing Unplanned Health Care Utilization

Postoperative phone calls ideally proactively identify concerns. This study aimed to determine whether postoperative phone calls after elective outpatient pediatric urology surgery were associated with differences in postoperative healthcare utilization. This retrospective cross-sectional study included patients undergoing elective outpatient pediatric urologic surgery in selected months of 2019-2021. Data were abstracted on patient demographics, postoperative call completion, number and timing of parent-initiated calls within 30d, concerns for parent-initiated calls, and timing and indication for emergency department visits within 30d. Patients with and without completed postoperative calls were compared. Of 1494 patients, 416 (38.6%) had completed postoperative phone calls; 1078 (61.4%) did not. Calls were more likely to be completed in more disadvantaged areas (Area Deprivation Index deciles 9-10; odds ratio [OR]=3.87, 95% confidence interval [CI]: 2.70-5.54, P<0.0001). Overall, the proportions of patients seeking emergency care within 30d (3.6% versus 4.0%, OR=0.90, 95% CI: 0.49-1.64, P=0.73) and with parent-initiated phone calls (31.7% versus 31.3%, OR=1.02, 95% CI: 0.80-1.20, P=0.86) were similar in patients with and without postop calls completed. For children in less disadvantaged areas (Area Deprivation Index decile 1-2), the likelihood of a parent-initiated call was higher when postop calls were completed (47.8% versus 33.6%, OR=1.79, 95% CI: 1.15-2.79, P=0.01). Routine postoperative phone calls within 72h of outpatient pediatric urologic surgery are not associated with decreased overall postoperative health care utilization, and in some cases are associated with an increase in calls to clinic. Defining patient and provider expectations for postoperative contact may make postoperative calls more useful.

National Postoperative Opioid Prescribing Rates Following Pediatric Urology Procedures Before and After the 2018 American Academy of Pediatrics Challenge to Reduce Opioid Prescribing: A Claims Database Analysis

To evaluate trends in opioid prescribing rates following pediatric urologic surgery. We queried the TriNetX Research database for patients under age 18 who underwent one of seven common pediatric urology procedures. We identified the proportion of patients that received an oral opioid prescription within 5days of surgery. The primary analysis evaluated the trend in postoperative opioid prescriptions using 3-month intervals from January 2010 to December 2022. We performed an interrupted time series analysis assessing trends in opioid prescribing patterns both before and after the American Academy of Pediatrics challenge. Of the 81,644 pediatric urology procedures, 29,595 (36.2%) received a postoperative opioid prescription, including 29.8% of circumcisions, 25.8% of hydrocelectomies, 39.6% of hypospadias repairs, 42.7% of pyeloplasties, 42.8% of ureteral reimplants. For all procedures we observed rising rates of opioid prescribing, increasing by 0.9% per 3-month interval prior to the challenge statement release from 2010 to 2018. We observed an overall significant decrease in opioid prescribing by 2.2% per 3-month interval following the challenge statement release. Additionally, since 2018, there was a significant decrease in opioid prescribing in all of the race, ethnicity, and age cohorts. Opioid prescribing following pediatric urology procedures has sharply decreased following the 2018 American Academy of Pediatrics challenge statement which underscores the value of cross-specialty quality improvement initiatives. Nonetheless, opioid prescribing remains high with potential racial or age disparities that warrant further investigation.

Association between YouTube® videos and health literacy with postoperative healthcare utilization following pediatric urologic surgery: A randomized trial

Limited caregiver health literacy has been associated with poorer health outcomes in pediatric patients and may limit caregiver understanding of printed education resources. Postoperative healthcare utilization may be related to confusion about instructions or complications. To correlate caregiver health literacy and educational video intervention with postoperative healthcare utilization following ambulatory pediatric urologic surgery. From July through December 2021, a randomized double-blinded trial assessed postoperative healthcare utilization following pediatric urologic surgery. Caregivers were randomized to receive standardized postoperative counseling and printed instructions (control) or access to English-language educational YouTube® videos with standardized postoperative counseling and printed instructions (intervention). Medical record abstraction was completed 30 days following surgery to identify postoperative healthcare utilization with calls, messages, add-on clinic visits, or presentation for urgent or emergent care, and postoperative complications. Target enrollment was achieved with 400 caregivers with 204 in the intervention and 196 in the control groups. There was a 32.5% overall rate of postoperative healthcare utilization. Health literacy was inversely associated with total postoperative healthcare utilization (p<0.001). There was no difference in the incidence of postoperative healthcare utilization between the control and intervention groups (p=0.623). However, on sub-analysis of caregivers with postoperative healthcare utilization (Summary Figure), there were fewer total occurrences in the intervention group (intervention median 1, IQR 1,2.3; control median 2, IQR 1,3; p<0.001). For caregivers with limited health literacy, there was a greater associated reduction in median calls from 2 (IQR 0,2) to 0 (IQR 0,0.5) with video intervention (p=0.016). On multivariate analysis, total postoperative healthcare utilization was significantly associated with limited caregiver health literacy (OR 1.08; p=0.004), English as preferred language (OR 0.68; p=0.018), and older patient age (OR 0.95; p=0.001). Current resources for postoperative education are limited as resources can be written above recommended reading levels and families can have difficulty recalling information discussed during postoperative counseling. Video intervention is an underutilized resource that can provide an additional resource to families with visual and auditory aids and be accessed as needed. Caregiver health literacy was inversely associated with postoperative healthcare utilization. There was no difference in the incidence of postoperative healthcare utilization with video intervention. However, on subgroup analysis, supplemental videos were associated with fewer occurrences of postoperative healthcare utilization, especially in caregivers with limited health literacy. On multivariate regression, health literacy, preferred language, and patient age were significantly associated with total postoperative healthcare utilization.