Journal of Pediatric Surgery Open最新文献

{"title":"Association of social vulnerability and rehospitalization in pediatric motor vehicle trauma patients","authors":"Meagan Rosenberg ,&nbsp;Alexander Knee ,&nbsp;Aixa Perez Coulte ,&nbsp;Michael V. Tirabassi","doi":"10.1016/j.yjpso.2024.100161","DOIUrl":"10.1016/j.yjpso.2024.100161","url":null,"abstract":"<div><h3>Introduction</h3><p>We investigated social vulnerability index (SVI) as a tool to identify children at risk for readmission following motor vehicle collisions (MVC).</p></div><div><h3>Materials and Methods</h3><p>An exploratory retrospective cohort study was conducted of pediatric trauma activations (age 0–15) for MVCs 1/1/2012 to 6/30/2022 at a level 1 trauma center. Eligibility included residence within our center's catchment area. Excluded were mortalities during the index admission. Patient address was geocoded and linked with state-level census tract SVI. Per the CDC, SVI ≥90th percentile defined high vulnerability. We evaluated SVI theme: socioeconomic status (SES), household composition and disability (HCD), minority status and language (MSL), housing and transportation (HT). Outcomes included emergency department (ED) visits and re-hospitalization within 90 days of discharge. Kaplan-Meier plots, relative risk (aRR), and 95 % confidence intervals (95 %CI) adjusted for injury severity score (ISS) were estimated using log-binomial regression.</p></div><div><h3>Results</h3><p>Of 429 eligible subjects, 122 (28 %) resided in high SVI communities. High SVI patients had slightly higher mean ISS (8.6 vs 7.5). There was a similar risk of ED re-presentation across SVI groups (aRR=1.18; 95 %CI 0.61–2.29). However, although estimates were unstable, there was a possibility of increased risk of re-hospitalization among the high SVI group (aRR=2.34; 95 %CI 0.68–8.04). By theme, HT had the strongest association (aRR=1.71) for ED representation, whereas SES and HCD had the strongest associations for rehospitalization (aRR=2.03, 2.66, respectively).</p></div><div><h3>Conclusion</h3><p>We observed possible associations between high SVI and higher rates of re-hospitalization. Future research with a larger sample may clarify associations.</p></div><div><h3>Level of Evidence</h3><p>Level IV; Prognosis Study.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"8 ","pages":"Article 100161"},"PeriodicalIF":0.0,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000467/pdfft?md5=6b69c0987cfa5a18a3f8c0cc58296bd2&pid=1-s2.0-S2949711624000467-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141705245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of biobehavioral interventions in children undergoing surgery and associated patient-reported outcomes","authors":"Gwyneth A. Sullivan ,&nbsp;Yao Tian ,&nbsp;Willemijn L.A. Schäfer ,&nbsp;Kayla M. Giger ,&nbsp;Maxwell Joseph Willberding ,&nbsp;Audra J. Reiter ,&nbsp;Bonnie Essner ,&nbsp;Andrew J. Hu ,&nbsp;Martha C. Ingram ,&nbsp;Salva Balbale ,&nbsp;Julie K. Johnson ,&nbsp;Jane L. Holl ,&nbsp;Mehul V. Raval","doi":"10.1016/j.yjpso.2024.100159","DOIUrl":"10.1016/j.yjpso.2024.100159","url":null,"abstract":"<div><h3>Background</h3><p>: Biobehavioral interventions including relaxation, distraction, and mindfulness meditation exercises have been shown to decrease perioperative stress, anxiety, and pain. Our aims were to 1) quantify pediatric surgical patient-reported pre-operative exposure to and post-operative use of biobehavioral interventions; 2) understand barriers and facilitators to incorporation of biobehavioral interventions into clinical practice; and 3) evaluate associated patient-reported outcomes.</p></div><div><h3>Methods</h3><p><em>:</em> We conducted an embedded mixed-methods study with a quantitative focus. Data were collected as part of the 18-hospital ENhanced Recovery In CHildren Undergoing Surgery (ENRICH-US) clinical trial for children, ages 10–18 years, undergoing elective gastrointestinal surgery. Patients/caregivers were surveyed about preoperative exposure to and postoperative use of biobehavioral interventions. Four semi-structured group interviews with 20 pediatric surgery providers were conducted. Outcomes included pain-related functional disability, health-related quality of life (HRQoL), and perioperative nervousness.</p></div><div><h3>Results</h3><p><em>:</em> 41 % (<em>n</em> = 67) of 164 enrolled patients/caregivers reported preoperative exposure to and 71 % (<em>n</em> = 117) reported postoperative use of a biobehavioral intervention(s). Barriers to incorporation of biobehavioral interventions included lack of standardized workflows, clinician knowledge, and resources. Potential facilitators included media and peer-counseling. After adjusting for individual and hospital characteristics, those who reported using a biobehavioral intervention(s) were 70 % less likely to report worsened postoperative nervousness (95 % CI 0.10–0.91; <em>p</em> = 0.03). Reported use of a biobehavioral intervention(s) was not found to be associated with pain-related functional disability or HRQoL.</p></div><div><h3>Conclusions</h3><p><em>:</em> Use of a biobehavioral intervention(s) may stabilize postoperative nervousness of children undergoing surgery. There is a need for redesign of clinical workflows and clinician training to facilitate integration of biobehavioral interventions.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"8 ","pages":"Article 100159"},"PeriodicalIF":0.0,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000443/pdfft?md5=a3f602fe152265a0786fd9d56fcd2472&pid=1-s2.0-S2949711624000443-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141639420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Segmental intestinal reconfiguration (SIR) in combined reconstructions for ultrashort bowel syndrome","authors":"Vasily V. Nikolaev ,&nbsp;Julia Averyanova","doi":"10.1016/j.yjpso.2024.100158","DOIUrl":"10.1016/j.yjpso.2024.100158","url":null,"abstract":"<div><h3>Background</h3><p>Ultrashort bowel syndrome represents the most rare and complex variant of the short bowel syndrome. Autologous intestinal reconstructions for ultrashort bowel syndrome is typically reserved for severe cases characterized by symptomatic dysmotility within the ultrashort dilated segments. Limited surgical techniques are available to substantially increase the length of ultrashort bowels with asymmetric and highly dilated segments.</p><p>We present a case series detailing the application of a technique for lengthening and tapering significantly dilated ultrashort bowels – segmental intestinal reconfiguration (SIR), based on the Yang-Monti principle. Our analysis delves into the technical features across various anatomical variants and provides mid-term results.</p></div><div><h3>Methods</h3><p>From 2021 to 2022, patients experiencing dysmotility in dilated ultrashort bowel segments with a preserved colon underwent sequential combined intestinal reconstructions. Assessments were conducted 18–24 months post-surgery, and statistical calculations employed nonparametric methods to compare pre- and postoperative results.</p></div><div><h3>Results</h3><p>Six patients, with a median age of 48.5 months, underwent autologous intestinal reconstructions, including SIR. The serial transverse enteroplasty (STEP) was performed on the dilated duodenum in five children, and colon interposition in two. The length of the small bowel exhibited a significant difference before and after surgery (<em>p</em> = 0.031). No complications were observed in the postoperative period. The postoperative group demonstrated a lower dependence on parenteral nutrition (NPEI/REE &lt; 80 % in 6 (100.0 %); <em>p</em> = 0.007). Enteral autonomy was restored in two children.</p></div><div><h3>Conclusions</h3><p>The results of SIR technique in combined reconstructions for ultrashort bowel syndrome in a carefully selected cohort of children demonstrate feasibility and reliability, as well as the restoration of intestinal transport function at midterm evaluation. This comprehensive approach resulted in increased enteral tolerance and reduced parenteral requirements.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"8 ","pages":"Article 100158"},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000431/pdfft?md5=5c4615bdc1f13994ab332d608b77ec64&pid=1-s2.0-S2949711624000431-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141710046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-assisted thoracoscopic versus conventional thoracoscopic plication for diaphragmatic eventration in children: Comparison of mid-term outcomes","authors":"Mengxin Zhang ,&nbsp;Jingfeng Tang ,&nbsp;Yuan Liu ,&nbsp;Zhiqing Cao ,&nbsp;Kangtai Wang ,&nbsp;Guoqing Cao ,&nbsp;Xi Zhang ,&nbsp;Shao-tao Tang","doi":"10.1016/j.yjpso.2024.100157","DOIUrl":"10.1016/j.yjpso.2024.100157","url":null,"abstract":"<div><h3>Objective</h3><p>Minimally invasive surgery has been widely used for diaphragmatic eventration (DE). We aimed to compare the mid-term outcomes of robot-assisted thoracoscopic (RTP) and conventional thoracoscopic plication (CTP) for DE and to discuss the technical advantages of RTP.</p></div><div><h3>Methods</h3><p>From January 2015 to July 2022, the clinical outcomes of 30 RTP patients and 35 CTP patients were retrospectively analyzed. The baseline data, surgical outcomes and surgical technique will be compared in detail.</p></div><div><h3>Results</h3><p>The baseline data of two groups were comparable. No intraoperative conversion or complications occurred. The total operation time and intraoperative blood loss were similar between two groups, but RTP group had a significantly shorter diaphragmatic plication time compared to CTP group (25.77±3.55 min vs 44.49±4.43 min, <em>p</em> &lt; 0.001). The total surgical cost of RTP group was higher than that of CTP group (48,593.06±2752.33 RMB vs 25,181.23±5681.51 RMB, <em>p</em> &lt; 0.001). No significant differences were found in postoperative hospital stay, diclofenac suppository dosage, unplanned readmission rate within 30 days postoperatively, recurrence rate, or postoperative complications within 1 year postoperatively between RTP and CTP groups. Sixty patients had preoperative symptoms resolved or significantly improved with normal diaphragmatic position. However, two patients in CTP group encountered recurrence, and one patient in CTP group and two patients in RTP group had a diaphragm descent in only one intercostal space.</p></div><div><h3>Conclusion</h3><p>RTP is a feasible and effective minimally invasive option for the treatment of DE, with mid-term outcomes comparable to CTP, which has a great advantage in terms of easier suturing and free knotting. DE can serve as an ideal disease type to train robots for thoracoscopic surgery by young doctors.</p></div><div><h3>Level of evidence</h3><p>Level III.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"7 ","pages":"Article 100157"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S294971162400042X/pdfft?md5=dd9053abb546cc2e32d9b859710cde44&pid=1-s2.0-S294971162400042X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141630718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pedi-Bots: Innovations and progress in robotic pediatric general surgery","authors":"Krysta M Sutyak ,&nbsp;KuoJen Tsao","doi":"10.1016/j.yjpso.2024.100156","DOIUrl":"10.1016/j.yjpso.2024.100156","url":null,"abstract":"<div><p>Robotic Assisted Surgical Systems for abdominal surgery began human trials in adults in the 1990s [<span>1</span>,<span>2</span>]. The first commercially available system was approved for use in Europe and the United States by 2000 [<span>2</span>,<span>3</span>]. Almost 25 years later, robotic surgery is commonplace in most areas of general surgery in adults and is utilized nationally and internationally throughout most other surgical specialties. The first robotic pediatric surgery, a Nissan fundoplication, was completed in 2000 [<span>4</span>]. In relatively similar time periods where robotic surgery has become widespread in the adult population, its use has remained limited in pediatric patients. This is most often attributed to limitations secondary to the patient's size relative to the size of the robot and instruments[<span>5</span>,<span>6</span>]. In this article, we aim to review the robotic technology currently available in pediatrics, the advantages of robotic surgery, the use and safety of robotics in pediatric general surgery, and the challenges or limitations of its use, highlighting how surgeons and centers are utilizing this technology and implementing robotic practices despite these obstacles.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"7 ","pages":"Article 100156"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000418/pdfft?md5=b5e2b12710654b14d599da7858503d4d&pid=1-s2.0-S2949711624000418-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141408300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency Department Thoracotomy: A National Trauma Databank analysis","authors":"Taylor Glassman ,&nbsp;Sathyaprasad Burjonrappa","doi":"10.1016/j.yjpso.2024.100154","DOIUrl":"https://doi.org/10.1016/j.yjpso.2024.100154","url":null,"abstract":"<div><h3>Introduction</h3><p>Emergency Department Thoracotomy (EDT) warrants further investigation in the pediatric population due to concerns about its futility. Our study evaluates how patient demographics, injury characteristics, and physiologic status influence pediatric EDT outcomes in blunt and penetrating trauma.</p></div><div><h3>Methods</h3><p>This retrospective study analyzed patients ≤19 years who received EDT within 1 hour of arrival to the ED from the National Trauma Data Bank. Cases were stratified by blunt and penetrating trauma. Descriptive statistics and univariate analysis were used to identify predictors of survival post-EDT.</p></div><div><h3>Results</h3><p>Of the 1,075 pediatric patients who underwent Emergency Department Thoracotomy (EDT), 79.6 % experienced penetrating trauma and 20.4 % blunt trauma, with survival rates at 25.9 % and 9.1 %, respectively. Survivors of penetrating trauma typically presented with more stable vital signs, such as pulse rate, oximetry, and Glasgow Coma Scale (GCS) scores, and lower Injury Severity Scores (ISS), all correlating with survival (p &lt; 0.05). Survivors of blunt trauma were distinguished by higher respiratory rates and temperatures (p &lt; 0.05). Risk factor analysis indicated that age-adjusted bradycardia, age-adjusted hypotension, and pre-hospital cardiac arrest were significant predictors of mortality across trauma types (penetrating trauma: OR = 18.7, 6.2, and 20.7; blunt trauma: OR = 12, 2.69, and 6.4, all p &lt; 0.05). Notably, pre-hospital respiratory support was associated with a reduced risk of mortality for both types of trauma (OR = 0.32 for penetrating, and OR = 0.23 for blunt, p &lt; 0.05).</p></div><div><h3>Conclusions</h3><p>The study affirms the significance of pre-hospital care, showing that stable vitals and respiratory support enhance pediatric thoracotomy outcomes. Ongoing research into pediatric-specific trauma protocols are needed.</p></div><div><h3>Type of Study</h3><p>Retrospective cohort</p></div><div><h3>Level of Evidence</h3><p>III</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"7 ","pages":"Article 100154"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S294971162400039X/pdfft?md5=e6da275be2ccb8802f406569f3485361&pid=1-s2.0-S294971162400039X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141594142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Board Page","authors":"","doi":"10.1016/S2949-7116(24)00049-2","DOIUrl":"10.1016/S2949-7116(24)00049-2","url":null,"abstract":"","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"7 ","pages":"Article 100164"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000492/pdfft?md5=23bc44533f72d7ff8393a6e7a7e13ac2&pid=1-s2.0-S2949711624000492-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141843507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pilot study: Significance of I-FABP2 in the diagnosis of acute abdominal episodes in children","authors":"Szymon Gryboś ,&nbsp;Viera Karaffová ,&nbsp;Milan Kuchta ,&nbsp;Peter Krcho","doi":"10.1016/j.yjpso.2024.100146","DOIUrl":"10.1016/j.yjpso.2024.100146","url":null,"abstract":"<div><h3>Background</h3><p>Pediatric abdominal conditions, including necrotizing gastrointestinal diseases, pose significant diagnostic challenges due to clinic symptoms and limited diagnostic tools. Intestinal fatty acid binding protein 2 (I-FABP2) has emerged as a potential biomarker for intestinal damage, but its efficacy in diagnosing pediatric intestinal necrosis remains under explored.</p></div><div><h3>Methods</h3><p>A prospective study was conducted on 55 pediatric patients presenting with abdominal pain and suspected intestinal necrosis or intestinal perforation. Clinical, laboratory, and radiological data were collected, and intraoperative assessment of bowel necrosis was performed. Gene expression of I-FABP2 in peripheral blood was measured using Real-Time RT-PCR, and correlations with surgery and laboratory parameters were analyzed.</p></div><div><h3>Results</h3><p>Intraoperative assessment revealed a moderate sensitivity (61.1%) and specificity (73.7%) of I-FABP2 in identifying bowel necrosis. Positive predictive value (PPV) was high (81.5%), indicating a high likelihood of the condition when I-FABP2 is positive. However, the negative predictive value (NPV) was limited (50%), suggesting challenges in confidently excluding necrosis based on negative I-FABP2 results. Correlations were observed between I-FABP2 expression and elevated levels of C-reactive protein (CRP), interleukin-6 (IL-6), and white blood cell count (WBC), indicating its association with inflammatory processes.</p></div><div><h3>Conclusions</h3><p>While I-FABP2 shows promise as a biomarker for pediatric intestinal necrosis, its diagnostic utility may be enhanced when considered alongside other clinical parameters. Further research and validation studies are warranted to refine its clinical application and improve diagnostic accuracy in pediatric gastrointestinal conditions.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"8 ","pages":"Article 100146"},"PeriodicalIF":0.0,"publicationDate":"2024-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000315/pdfft?md5=21a1c6f80de62c71255bfa1aade16414&pid=1-s2.0-S2949711624000315-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142058488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immunohistochemistry study of PHOX2B expression in Hirschsprung's disease allied disorders","authors":"Huan Wang,&nbsp;Xiulei Sun,&nbsp;Likun Yu,&nbsp;Yiyuan Xu","doi":"10.1016/j.yjpso.2024.100148","DOIUrl":"10.1016/j.yjpso.2024.100148","url":null,"abstract":"<div><h3>Objective</h3><p>This study aimed to investigate the significance of PHOX2B expression in Hirschsprung's disease allied disorders (HAD).</p></div><div><h3>Methods</h3><p>Eight specimens of HAD were surgically resected and collected at Beijing Children's Hospital Affiliated to Capital Medical University Heilongjiang Hospital in recent years. Additionally, three specimens from patients with immature ganglion development in the intestinal wall and six control specimens from normal colons were also collected. PHOX2B, S-100, and CR antibodies were used for immunohistochemical staining to observe their expression at the mucosal, submucosal, and intrinsic muscular layer ganglia.</p></div><div><h3>Results</h3><p>In the control group,the nuclei of the submucosal and myenteric ganglion cells showed strong or weak PHOX2B staining pattern,the mature ganglion cells showed weak PHOX2B staining,and the immature ganglion cells showed strong staining;S-100 only stained nerve fibers but not ganglion cells; CR stained nerve fibers in the mucosal layer and submucosal layer and also stained ganglion cells. These three antibodies showed different expression patterns in poorly developed enteric ganglia and immature enteric ganglion cells.</p></div><div><h3>Conclusion</h3><p>PHOX2B is only expressed in the nucleus of ganglion cells, has discriminatory significance in identifying mature and immature ganglion cells, and is an essential marker for diagnosing HAD.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"7 ","pages":"Article 100148"},"PeriodicalIF":0.0,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000339/pdfft?md5=10649e1203efdabd43cc634633648df5&pid=1-s2.0-S2949711624000339-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141401420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-reduction observation and recurrence of pediatric intussusception in New Zealand: A national multicenter retrospective study","authors":"Brodie M. Elliott ,&nbsp;Jonathan M. Wells ,&nbsp;Shona Naera ,&nbsp;Andrew Weston ,&nbsp;Jacqueline Copland ,&nbsp;Shirin Gosavi ,&nbsp;Kristine Jung ,&nbsp;Udaya Samarakkody ,&nbsp;Georges K. Tinawi ,&nbsp;Samuel Haysom ,&nbsp;Rieke L. Meister ,&nbsp;Christopher I. Cassady ,&nbsp;Stephen Evans","doi":"10.1016/j.yjpso.2024.100155","DOIUrl":"https://doi.org/10.1016/j.yjpso.2024.100155","url":null,"abstract":"<div><h3>Background</h3><p>Intussusception is the most common cause of preschool intestinal obstruction. International data suggest that following uncomplicated enema reduction, 4-hour observation with prompt return to oral diet is safe. We aimed to investigate the rate and timing of intussusception recurrence across Aotearoa New Zealand, compared to the cost of routine post-reduction observation.</p></div><div><h3>Methods</h3><p>We performed a national 15-year retrospective, multicenter cohort study of all children treated for intussusception between 01 Jan 2007 and 01 Jan 2022 across AoNZ. A robust clinical dataset was collected using a REDCap proforma. We also investigated the financial and time costs of current in-hospital observation practices.</p></div><div><h3>Results</h3><p>During this period, primary enema reduction without general anesthetic was successful in 339 cases, requiring a median of 2 attempts (1–8). The median age was 0.8 years; 70.8% were male, and 17.1% were Māori. The median length of hospital stay was 25.9 h, primarily comprised of post-reduction observation (21.6 h). Intussusception recurrence within 30 days occurred in 29 children (8.5%) at a median time of 24.7 h post-reduction. Of the 19 cases recurring before discharge, 12 (3.5%) recurred between 4 and 24 h. The median observation period for those with successful primary enema reduction was 21.6 h; if reduced to 4 h, savings of NZD 883,632 (USD 529,825) and 7342 ward hours were possible.</p></div><div><h3>Conclusions</h3><p>Nationally, the intussusception recurrence rate after uncomplicated enema reduction was 8.5%, but only 3.5% occurred between the 4–24 hour period post-reduction. Expediting discharge by avoiding routine overnight observation appears safe and economically viable.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"7 ","pages":"Article 100155"},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000406/pdfft?md5=c60ac96156584f54e099bc3c49f4db4d&pid=1-s2.0-S2949711624000406-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141323365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}