Journal of pediatric surgery最新文献

{"title":"Geographic Differences in Pediatric Surgical Mortality in Canada: A Retrospective Cohort Study","authors":"Oluwatomilayo Daodu ,&nbsp;Saffa Aziz ,&nbsp;Melanie Morris ,&nbsp;Mary E. Brindle","doi":"10.1016/j.jpedsurg.2024.07.030","DOIUrl":"10.1016/j.jpedsurg.2024.07.030","url":null,"abstract":"<div><h3>Objective</h3><div>This study describes differences in postoperative mortality for pediatric patients in rural communities compared to urban communities.</div></div><div><h3>Background</h3><div>Canada has the second largest land mass in the world, with a population density of 4 people per km². There are 18 children’s hospitals in Canada offering pediatric surgical services, all in urban centres, yet nearly one-fifth of the population lives in rural or remote communities. Children who live in rural settings may have worse surgical outcomes, including mortality rates, compared with urban populations.</div></div><div><h3>Methods</h3><div>Pediatric patients, from birth to 18 years old, who had surgery from January 1, 2011, to December 31, 2021, at a single Children's Hospital were included in the study. Data was obtained from the provincial Operating Room Information System (ORIS) database. Postal code, rural and urban status, distance to children's hospital (0-50 km, 51-100 km, 101-150 km, 151-200 km, and &gt;200 km), and procedure urgency were collected. 30-day mortality for all procedures was collected.</div></div><div><h3>Results</h3><div>85,998 surgical procedures were performed at ACH between 2011 and 2021. 17,773 (20.7%) of patients lived &gt;50 km or more from the hospital – 5,329 (6.2%) 51- 100 km, 4,053 (4.7%) 101-150 km, n=2,323 (2.7%) 151-200 km, and 6,070 (7.1%) &gt;200 km. Rural patients had higher 30-day mortality rates than urban patients, with an odds ratio of mortality (rural vs urban) of 2.30 (95% CI, 0.95 to 5.60). When stratified by distance, patients living closer to the hospital (0-50 km) had lower odds of mortality.</div></div><div><h3>Conclusions</h3><div>Canadian Rural patients have higher operative mortality risks than urban patients. This study identifies a vulnerable group of patients who do not have equal access to care and may experience worse outcomes.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 2","pages":"Article 161645"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142004410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional Outcome in Patients With Anorectal Malformation With Recto-prostatic or Recto-bulbar Urethral Fistula and Comparison Between Different Surgical Approaches: A Multi-center Study","authors":"Carol Wing Yan Wong ,&nbsp;Hiroyuki Koga ,&nbsp;Koshiro Sugita ,&nbsp;Daiki Kato ,&nbsp;Annika Mutanen ,&nbsp;Patrick Ho Yu Chung ,&nbsp;Go Miyano ,&nbsp;Toshio Harumatsu ,&nbsp;Satoshi Ieiri ,&nbsp;Yoichi Nakagawa ,&nbsp;Hiroo Uchida ,&nbsp;Mikko P. Pakarinen ,&nbsp;Kenneth Kak Yuen Wong","doi":"10.1016/j.jpedsurg.2024.07.037","DOIUrl":"10.1016/j.jpedsurg.2024.07.037","url":null,"abstract":"<div><h3>Purpose</h3><div>To analyze and compare the outcomes in patients with anorectal malformation with rectoprostatic and rectourethral fistula between laparoscopic-assisted anorectoplasty (LAARP) versus posterior sagittal anorectoplasty (PSARP).</div></div><div><h3>Method</h3><div>We performed a retrospective review on all males with anorectal malformation (ARM) with recto-prostatic (ARM-RP) or recto-bulbar urethral fistula (ARM-RB) treated in five tertiary paediatric surgical centres in the past 25 years. Defecative function was assessed using the Krickenbeck classification and Kelly's score. Functional outcomes between patients with LAARP and PSARP were compared.</div></div><div><h3>Results</h3><div>There were a total of 136 males with ARM-RP and ARM-RB for analysis, among which 73 (53.7%) had ARM-RP and 63 (46.3%) had ARM-RB. The median age of the patients was 9.4 years (range 0.8–24.7 years) and the median age at operation was 0.4 years (0 day–3.1 years). 57 (41.9%) and 79 patients (58.1%) underwent PSARP and LAARP respectively. 34 patients (25%) had VACTERL association. 111 (81.6%) and 103 patients (75.7%) had sacral and spinal cord anomalies respectively. 19 patients (13.9%) eventually required Malone's Antegrade Continence Enema (MACE).</div><div>For the comparison between PSARP and LAARP, no difference in Kelly scores (4.58 ± 1.63 versus 4.67 ± 1.36) was identified (p = 0.79). Logistic regression for voluntary bowel movement showed that VACTER association (p = 0.02) and fistula location (p = 0.01) were significant prognostic factors, whereas the operation approach (PSARP or LAARP) was not (p = 0.65).</div></div><div><h3>Conclusion</h3><div>VACTERL association and fistula location were significant prognostic factors for voluntary bowel movement, and there appeared to be no significant difference in functional outcome between PSARP and LAARP.</div></div><div><h3>Level of Evidence</h3><div>IV.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 2","pages":"Article 161652"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High Alvarado Score is Independently Associated with Appendicitis in Children with Inconclusive Ultrasound","authors":"Mohamed Jallouli,&nbsp;Ahmed Elsharkawy,&nbsp;Ahmed Bahgat Soliman,&nbsp;Mohamed Zouari","doi":"10.1016/j.jpedsurg.2024.161692","DOIUrl":"10.1016/j.jpedsurg.2024.161692","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 2","pages":"Article 161692"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Routine Urology Consultation and Follow-up After Pediatric Blunt Renal Trauma is Likely Unnecessary","authors":"Christopher Clinker ,&nbsp;Jack Scaife ,&nbsp;Chance Basinger ,&nbsp;Kacey L. Barnes ,&nbsp;Christopher Roach ,&nbsp;Glen A. Lau ,&nbsp;Sidney Norton ,&nbsp;Robert A. Swendiman ,&nbsp;Katie W. Russell","doi":"10.1016/j.jpedsurg.2024.161886","DOIUrl":"10.1016/j.jpedsurg.2024.161886","url":null,"abstract":"<div><h3>Introduction</h3><div>This study examines the outcomes of high-grade renal trauma in pediatric patients and evaluates the intervention rate. In our hospital, we routinely consult urology on all high-grade injuries. We anticipated minimal intervention, casting doubt on the need for routine urology consultation and follow-up.</div></div><div><h3>Methods</h3><div>We conducted a retrospective review at a single pediatric trauma center from January 2018 to June 2023, focusing on patients with severe (grade III-V) renal injuries. Data collected included demographics, trauma-related variables, hospital course, interventions, and follow-up. When the grade was not readily available in the electronic medical record, we had a board-certified pediatric radiologist review the imaging and provide the grade. Follow-up was included only if it was with a pediatric urologist.</div></div><div><h3>Results</h3><div>There were 92 patients that met our inclusion criteria. Of these, 47 were grade III, 32 were grade IV, and 13 were grade V. Six (6.5%) patients required inpatient renal stent procedures. Follow-up occurred in 55/92 (60%) patients with a pediatric urologist. Follow-up by grade is as follows: 22/47 (47%) grade III, 22/32 (69%) grade IV, and 11/13 (85%) grade V. Overall 5.8% of patients required antihypertensive medications and this was more likely as injury grade increased. All stents were removed outpatient and there were 3 (3.3%) additional outpatient interventions, all in patients that were symptomatic.</div></div><div><h3>Conclusion</h3><div>Given the low prevalence of interventions after discharge, routine consultation and follow-up with urology is likely unnecessary in the absence of an inpatient urologic procedure during the index hospitalization. Patients with high-grade injuries should instead follow up with a trauma clinic or general provider with urology follow-up based on symptoms.</div></div><div><h3>Type of Study</h3><div>Retrospective Review.</div></div><div><h3>Level of Evidence</h3><div>Level III.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 2","pages":"Article 161886"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the Grosfeld Career Development Award on the Academic Success of Pediatric Surgeon-Scientists","authors":"Oluyinka O. Olutoye II ,&nbsp;Michael B. Gyimah ,&nbsp;Anjali Degala,&nbsp;Taylor Lee,&nbsp;Sundeep G. Keswani,&nbsp;Shaun M. Kunisaki,&nbsp;Lily S. Cheng","doi":"10.1016/j.jpedsurg.2024.161969","DOIUrl":"10.1016/j.jpedsurg.2024.161969","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 2","pages":"Article 161969"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Implementation of the Neonatal Enhanced Recovery After Surgery Guideline","authors":"Brandon Pentz ,&nbsp;Palak Patel ,&nbsp;Mercedes Pilkington ,&nbsp;Oluwatomilayo Daodu ,&nbsp;Jennifer Y.K. Lam ,&nbsp;Alexandra Howlett ,&nbsp;Lori Stephen ,&nbsp;Adam Spencer ,&nbsp;Jennifer Unrau ,&nbsp;Michelle Theam ,&nbsp;Mary E. Brindle","doi":"10.1016/j.jpedsurg.2024.06.021","DOIUrl":"10.1016/j.jpedsurg.2024.06.021","url":null,"abstract":"<div><h3>Introduction</h3><div>Enhanced Recovery After Surgery (ERAS®) protocols require multidisciplinary team engagement from healthcare professionals (HCPs), where limited studies exist on neonatal ERAS®protocols. Therefore, we aimed to capture perceptions of HCPs on facilitation and implementation of the neonatal ERAS®guideline.</div></div><div><h3>Methods</h3><div>10 neonates were recruited. 13 HCPs involved in these patient's care were interviewed and 8 surveyed consisting of pediatric anesthesiologists, neonatologists, neonatal intensive care unit (NICU) registered nurses (RNs), and pediatric surgeons. Using a multi-methods design, recruitment, semi-structured interviews and surveys were conducted from May 17, 2021 to November 1, 2022. Data was coded using The Promoting Action on Research Implementation in Health Studies and then thematically analyzed.</div></div><div><h3>Results</h3><div>Interviews were conducted with 4 pediatric anesthesiologists, 4 neonatologists, 2 NICU RNs, and 3 pediatric surgeons and surveys with 1 pediatric anesthesiologist, 2 neonatologists, 3 NICU RNs, and 2 pediatric surgeons. From interviews, the top 3 facilitation strategies were utilization of: (1) multidisciplinary guideline champions, (2) reminders and education, and (3) results to facilitate adherence. Incorporation of these strategies resulted in perceived: (1) stronger buy-in and engagement and (2) improved team communication, job satisfaction, care quality, and parental involvement.</div></div><div><h3>Conclusion</h3><div>HCPs stressed the importance of guideline champions, reminders and education, and results distribution. Given implementation during the COVID-19 pandemic, awareness and education were mixed. Nonetheless, HCPs perceived improved buy-in and engagement, communication, job satisfaction, quality of care, and parental involvement. Incorporation of these strategies can promote successful ERAS® guideline facilitation and implementation and should be considered for future ERAS® projects.</div></div><div><h3>Level of Evidence</h3><div>IV.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 2","pages":"Article 161613"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141700415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Children With Short Bowel Syndrome: Experiences in a Multidisciplinary Intestinal Rehabilitation Unit Over Two Decades","authors":"Jaime Tsz-wing Tsang ,&nbsp;Adrian Chi-heng Fung ,&nbsp;Stephen Cheuk-lam Lau ,&nbsp;Kenneth Kak-yuen Wong","doi":"10.1016/j.jpedsurg.2024.07.031","DOIUrl":"10.1016/j.jpedsurg.2024.07.031","url":null,"abstract":"<div><h3>Background</h3><div>Short bowel syndrome (SBS) is a rare but serious form of organ failure, and patients with SBS depend on total parenteral nutrition (PN) to maintain growth and development. The present study aimed to evaluate the experiences and outcomes of children with SBS managed by a multidisciplinary intestinal rehabilitation programme in a tertiary paediatric centre.</div></div><div><h3>Methods</h3><div>A retrospective single-centre analysis of all paediatric patients with a clinical diagnosis of SBS between 2001 and 2022 was performed. Clinical outcomes and their predictors were extracted and analysed.</div></div><div><h3>Results</h3><div>Of the 64 children included in the study, 43 (67%) had extensive necrotising enterocolitis. The median bowel length was 45 cm (interquartile range (IQR) = 18–65) and 18.9% (IQR = 10–28.5) of the expected length based on age. Over a mean follow-up period of 8.9 years, 57 patients (89%) survived, and 50 (78%) weaned off PN. The presence of intestinal failure-associated liver disease (IFALD) (OR = 6.375, <em>p</em> = 0.02) and patients managed before the introduction of fish oil-based PN in 2007 (OR = 5.895, <em>p</em> = 0.001) were significant predictors of mortality. There was an overall improvement in survival over time (<em>p</em> = 0.003). Ultrashort bowel length was not associated with significantly higher mortality (OR = 1.1, <em>p</em> = 0.65) but was a poor prognostic factor for weaning off PN (OR = 3.57, p = 0.004). Among all patients who weaned off PN, two had bowel lengthening procedures and one received a glucagon-like peptide 2 (GLP-2) analogue.</div></div><div><h3>Conclusions</h3><div>A multidisciplinary intestinal rehabilitation programme offers a comprehensive approach for patients with SBS and has been shown to be effective with favourable outcomes. Improvements in the choice of PN and the development of new treatment strategies potentially improved the survival and enteral autonomy of SBS patients.</div></div><div><h3>Level of Evidence</h3><div>III.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 2","pages":"Article 161646"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141772360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Congenital Risk Factors for Chronic Kidney Disease in Patients With Persistent Cloaca: Results From a Nationwide Survey in Japan","authors":"Ayaka Nagano ,&nbsp;Toshio Harumatsu ,&nbsp;Koshiro Sugita ,&nbsp;Masakazu Murakami ,&nbsp;Keisuke Yano ,&nbsp;Shun Onishi ,&nbsp;Takafumi Kawano ,&nbsp;Satoshi Ieiri ,&nbsp;Masayuki Kubota","doi":"10.1016/j.jpedsurg.2024.07.015","DOIUrl":"10.1016/j.jpedsurg.2024.07.015","url":null,"abstract":"<div><h3>Background</h3><div>We conducted a nationwide survey of persistent cloaca (PC) to investigate the renal function outcomes and factors affecting chronic kidney disease (CKD) in patients with PC.</div></div><div><h3>Method</h3><div>Information from 466 patients with PC was obtained via a questionnaire in this study. The 290 patients (62.2%) with renal function data were classified into 2 groups based on their estimated glomerular filtration rate: advanced CKD group (&lt;30 mL/min/1.73 m² [or post-renal replacement therapy]) and non-advanced CKD group (≥30 mL/min/1.73 m²). Univariate and multivariate analyses were performed to identify risk factors for CKD that may affect the renal function, including renal and urinary tract malformations, associated anomalies, and urinary tract treatment. The advanced CKD group was divided into two groups based on age to evaluate age-related differences (younger- and older-age CKD groups).</div></div><div><h3>Results</h3><div>A regression analysis revealed that congenital renal malformations (odds ratio [OR]: 14.06, 95% confidence interval [CI]:3.07–131.65, <em>p</em> &lt; 0.0001), urinary tract obstruction (OR:4.28, 95%CI:1.12–24.23, <em>p</em> &lt; 0.05), and sacral agenesis (OR:4.54, 95% CI:0.84–30.67, <em>p</em> &lt; 0.05) were significantly associated with advanced CKD. In the univariate analysis of factors affecting the renal prognosis, clean intermittent catheterization (CIC) (OR:4.18, 95%CI:1.21–16.45, <em>p</em> = 0.015), vesicostomy (OR:3.65, 95%CI:1.11–12.98, <em>p</em> = 0.019), and surgery for vesicoureteral reflux (OR:5.43, 95%CI:1.41–22.73, <em>p</em> = 0.006) were significantly associated with advanced CKD. Based on the univariate analysis, hydrometrocolpos was significantly more prevalent in the older-age CKD group compared to the younger-age CKD group (<em>p</em> &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>CKD development in patients with PC is influenced by a complex interplay of factors, including renal malformations and neurogenic bladder dysfunction due to spinal anomalies.</div></div><div><h3>Level of Evidence</h3><div>III (Study of Diagnostic Test, Study of nonconsecutive patients, and/or without a universally applied “gold” standard).</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 2","pages":"Article 161630"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141851586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medium-to Long-term Outcomes of Rex Shunt in 105 Children With Extrahepatic Portal Vein Obstruction in China","authors":"Jieqin Wang ,&nbsp;Yu Ning ,&nbsp;Huifang Ren ,&nbsp;Miao Hong ,&nbsp;Fuyu You ,&nbsp;Xiaoling Bai ,&nbsp;Xiaopan Chang ,&nbsp;Qifeng Liang ,&nbsp;Jiankun Liang ,&nbsp;Zhe Wen","doi":"10.1016/j.jpedsurg.2024.161930","DOIUrl":"10.1016/j.jpedsurg.2024.161930","url":null,"abstract":"<div><h3>Purpose</h3><div>The aim of our study was to analyze the medium-to long-term outcomes of Rex shunts in a large series of children with extrahepatic portal vein obstruction (EHPVO).</div></div><div><h3>Methods</h3><div>The clinical data of 105 children aged between 6 months and 16 years with EHPVO who underwent Rex shunt between October 2014 and June 2021 at our center were retrospectively reviewed after more than 2 years of follow-up.</div></div><div><h3>Results</h3><div>The overall patency rate of the Rex shunt was 91.43% (96/105) during a median follow-up of 41 months (range, 24–98 months). Eighty-seven (82.86%) of the 105 patients underwent classical Rex shunt with internal jugular vein (IJV) bypass, and the remaining 18 patients (17.14%) underwent modified Rex shunt with intra-abdominal vein bypass. Patients with a patent shunt experienced portal hypertension resolution, which was characterized by a reduction in portal pressure, disappearance of variceal bleeding, relief of gastroesophageal varices, and relief of splenomegaly or hypersplenism. The rate of Rex shunt thrombosis in our center was 8.57% (9/105), and a repeat Rex shunt was effective for the treatment of graft thrombosis. Anastomotic stenosis occurred in 14.26% (15/105) of the children, 38.46% (5/13) of whom received successful endovascular intervention therapy and experienced remission of portal hypertension symptoms. The patency rate of the classical Rex shunt was higher than that of the modified Rex shunt (97.70% vs. 61.11%), whereas the rate of vascular complications, including anastomotic stenosis and graft thrombosis, of the classical Rex shunt was lower than that of the modified Rex shunt (11.49% vs. 77.78%). Further comparison revealed that the risk of vascular complications was substantially greater in the modified Rex shunt group than in the classical Rex shunt group in the nonadjusted model, minimally adjusted model, and fully adjusted model (RR ranged from 6.77 to 7.07, all <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>The Rex shunt provides medium-to long-term benefits for children with EHPVO. The classical Rex shunt with IJV bypass provides the best patency rate and the fewest vascular complications.</div></div><div><h3>Levels of Evidence</h3><div>Ⅲ</div></div><div><h3>Type of Study</h3><div>Retrospective comparative study.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 2","pages":"Article 161930"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“Connect & Share”: Collaboratively Addressing Moral Distress Among Pediatric Surgeons","authors":"Jason P. Sulkowski,&nbsp;Mindy B. Statter,&nbsp;Terry L. Buchmiller","doi":"10.1016/j.jpedsurg.2024.161978","DOIUrl":"10.1016/j.jpedsurg.2024.161978","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 2","pages":"Article 161978"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}