Journal of pediatric surgery最新文献

{"title":"The Age-stratified Cost of Biliary Atresia: A MarketScan®-Based Cost Analysis","authors":"Anastasia M. Kahan ,&nbsp;Anna Gongjoo Holley ,&nbsp;Joshua Horns ,&nbsp;Catalina Jaramillo ,&nbsp;M. Kyle Jensen ,&nbsp;Katie W. Russell ,&nbsp;Richard E. Nelson ,&nbsp;Benjamin S. Brooke ,&nbsp;Stephen Guthery ,&nbsp;Zachary J. Kastenberg","doi":"10.1016/j.jpedsurg.2025.162244","DOIUrl":"10.1016/j.jpedsurg.2025.162244","url":null,"abstract":"<div><h3>Introduction</h3><div>Biliary atresia (BA) is the leading cause of childhood liver failure requiring liver transplantation. Early diagnosis and Kasai portoenterostomy (KP) offer the only opportunity to avoid liver failure and transplantation. This study aimed to assess BA healthcare costs in the United States. We hypothesized that patients who underwent KP before 60 days of age would incur lower healthcare costs than patients who underwent KP at 60 days or older.</div></div><div><h3>Methods</h3><div>Using MarketScan® (Truven Health Analytics), we evaluated cumulative healthcare costs for BA patients who had KP at less than 60 days (early KP), at 60 days or older (late KP), or had liver transplant – primarily or following KP. Cumulative costs were calculated at one-, three-, and five-year intervals, stratified by age at KP and transplant status. ANOVA univariate and Gaussian multivariate analyses were performed.</div></div><div><h3>Results</h3><div>170 children with BA were identified: 86 underwent early KP (50.6 %), 78 underwent late KP (45.9 %), and six were primarily transplanted (3.5 %). 101 patients (59.4 %) were enrolled in their insurance plan at one year, 45 (26.4 %) at three years, and 23 (13.5 %) at five years. Predicted total costs at three years were $283,035 for early KP (no transplant), $738,958 for late KP (no transplant), and $1,015,806 for patients requiring transplant regardless of KP status.</div></div><div><h3>Conclusion</h3><div>The average healthcare costs for BA patients are significant and depend upon age at intervention. Nearly 90 % of children experience insurance discontinuity within five years of diagnosis. Early BA diagnosis is integral to optimizing outcomes and minimizing healthcare expenditures.</div></div><div><h3>Type of Study</h3><div>Retrospective cohort study.</div></div><div><h3>Level of Evidence</h3><div>3.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 5","pages":"Article 162244"},"PeriodicalIF":2.4,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143521024","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":"Adapting Perioperative Care for Neurodivergent Children - A Scoping Review.","authors":"Spandana Veeravalli, Maia Michaud, Judy Colton, Brenda Bourdeau, Samantha Sacks, Lindsay Hales, Elena Guadagno, Dan Poenaru","doi":"10.1016/j.jpedsurg.2025.162224","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2025.162224","url":null,"abstract":"<p><strong>Purpose: </strong>Routine procedures often pose heightened challenges for neurodivergent children, resulting in increased need for perioperative care compared to the general population. Healthcare professionals' reduced familiarity with infrequent neurodivergent diagnoses further underscores the necessity of evidence-based guidelines. As no guidelines currently exist, our study aims to review interventions, delineate key themes, and develop a checklist to aid healthcare professionals in navigating the perioperative process for neurodivergent patients.</p><p><strong>Methods: </strong>Following PRISMA-ScR guidelines, we searched 8 databases from inception until May 2023 for studies assessing perioperative interventions for neurodivergent children. Articles were included if they: (1) focused on the pediatric neurodivergent population, (2) evaluated an intervention that adapted perioperative care, and (3) represented an original research study. To increase the study's inclusiveness, patient partners' perspectives were incorporated into data analysis and interpretation.</p><p><strong>Results: </strong>Out of 7992 articles screened at title and abstract level, 144 were reviewed in full-text format and 29 included in the analysis. Three key themes were identified: use of individualized care plans (27.6 % of included articles), modulation of pre-procedural sedation (17.2 %), and use of innovative mobility devices to improve safety of patient transfers (10.3 %). Care plans were created in collaboration with caregivers, assessing patients' preferences, triggers, and communication style. A multidisciplinary therapeutic approach was deemed crucial, including child life specialists - mentioned in 62.5 % of care plans studies.</p><p><strong>Conclusion: </strong>Improving perioperative care for neurodivergent children centers on the evaluation of their individual needs, followed by designing personalized care plans which include tailored pharmacological and non-pharmacological interventions.</p><p><strong>Level of evidence: </strong>III (scoping review, with lowest level of evidence included being case-control study).</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162224"},"PeriodicalIF":2.4,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674084","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":"Reply to Letter to the Editor.","authors":"Valerie Bloomfield, Jeffrey Traubici, Priscilla P L Chiu, Sari Kives, Lisa Allen","doi":"10.1016/j.jpedsurg.2025.162245","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2025.162245","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162245"},"PeriodicalIF":2.4,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523607","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":"Failure to Significantly Reduce Radiation Exposure in Children With Suspected Appendicitis in the United States.","authors":"Cem Kaya, Ramazan Karabulut, Zafer Turkyilmaz, Kaan Sonmez","doi":"10.1016/j.jpedsurg.2025.162242","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2025.162242","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162242"},"PeriodicalIF":2.4,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515761","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":"Prolonged Psychological Burden on Parents Following Home-based Anal Dilation for Anorectal Malformation","authors":"Signe Olsbø ,&nbsp;Anders Telle Hoel ,&nbsp;Remi A. Karlsen ,&nbsp;Astrid I. Austrheim ,&nbsp;Hanne Ambrose ,&nbsp;Helene Gjone ,&nbsp;Marie Hamilton Larsen ,&nbsp;Kristin Bjørnland","doi":"10.1016/j.jpedsurg.2025.162246","DOIUrl":"10.1016/j.jpedsurg.2025.162246","url":null,"abstract":"<div><h3>Aim</h3><div>Assess parents' experiences with home-based anal dilations in children with anorectal malformation (ARM).</div></div><div><h3>Methods</h3><div>Parents of children with ARM who had undergone home dilations (n = 240) were invited to complete the Impact of Event Scale (IES) questionnaire to measure post-traumatic stress symptoms (PTSS) and a study-specific form. Thematic analysis of free-text responses was done following Braun &amp; Clarke's method. Ethical approval was obtained.</div></div><div><h3>Results</h3><div>142 parents (59 % mothers) of 97 ARM children participated. The mean duration of home dilation was 4.5 months (SD 3.6) with a median time since the last dilation of 10 (0–20) years. 136 parents completed the IES questionnaire; 83/136 (61 %) presented PTSS. 40/136 (29 %) had moderate and 15/136 (11 %) severe symptoms. Mothers had higher average IES scores than fathers (17 vs 9, maximum score 75, p = 0.04). Parents who performed dilations exclusively preoperatively had less PTSS than those who did so postoperatively (7 vs 18, p = 0.03). 40 % had wanted more comprehensive training and support, and 43 % preferred healthcare professionals to perform dilations. Home dilations were prematurely terminated in one third of children because parents could not cope. Thematic analysis revealed three major themes: Emotional impact of the dilation procedure, Practical challenges performing dilations and Need for support and training.</div></div><div><h3>Conclusion</h3><div>Many ARM parents continue to experience PTSS long after completing home-based dilations. These results show that parents need better practical and psychological support when performing dilations. Parents who find the procedure very stressful should be offered to not do the dilations, and alternative solutions must be proposed.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 5","pages":"Article 162246"},"PeriodicalIF":2.4,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511970","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":"Clinical Features and Surgical Procedures of Acquired Rectovestibular Fistula: A Single-center Retrospective Study","authors":"Yan Li,&nbsp;Dazhi Ren,&nbsp;Heying Yang,&nbsp;Ming Yue,&nbsp;Beibei Sun,&nbsp;Kun Song,&nbsp;Xue'er Li","doi":"10.1016/j.jpedsurg.2025.162237","DOIUrl":"10.1016/j.jpedsurg.2025.162237","url":null,"abstract":"<div><h3>Introduction</h3><div>We reviewed a 7-year experience (Jan 2016 to Oct 2023) in diagnosing and surgically treating Acquired Rectovestibular Fistula (ARVF). Our study describes the medical history, introduces new classifications based on fistula features, and outlines the application of diverse surgical techniques in treating these patients.</div></div><div><h3>Methods</h3><div>A total of 78 girls with ARVF appeared asymptomatic at birth. Most patients experienced diarrhea or perineal inflammation within their first three months of life, followed by fistula formation and occasional fecal leakage and gas from the vestibule. The median age at surgery was 4 years (7 months–11 years). Fistulas were classified into four types based on diameter, location, and number, with corresponding surgical procedures: Type I (n = 52) underwent transrectal repair; Type II (n = 17) underwent transrectal fistulectomy and repair; Type III (n = 7) and Type IV (n = 2) underwent rectal-vestibular pull-through fistula excision or complete destruction, followed by transrectal repair.</div></div><div><h3>Results</h3><div>Primary healing occurred in 76 patients (97.4 %), with discharge occurring within 5–7 days postoperatively. Complications arose in 2 cases: one involved a Type IV fistula incision infection that resolved with daily sitz baths, and the other involved a Type III fistula recurrence that necessitated reoperation. All 78 patients had normal perineal appearance, with no incidences of urinary or fecal incontinence or anal stricture during the 2-month to 6-year follow-up period.</div></div><div><h3>Conclusions</h3><div>Choosing an appropriate surgical approach based on fistula classification for treating Acquired Rectovestibular Fistula (ARVF) leads to high success rates, low incidence of complications, and a favorable prognosis.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 5","pages":"Article 162237"},"PeriodicalIF":2.4,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511962","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":"Timely Diagnosis of Complete Anorectal Malformations in Newborns at Birth.","authors":"Chetan Khare, Sabavath Arun, Pooja Phulgirkar, Sattiraju Sarvani, Avantika Gupta","doi":"10.1016/j.jpedsurg.2025.162241","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2025.162241","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162241"},"PeriodicalIF":2.4,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468250","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":"Iterative Design and Manufacturing of a 3D-Printed Pediatric Open and Laparoscopic Integrated Simulator for Hernia Repair (POLISHeR).","authors":"Kayoung Heo, Eric Greaney, Julia Haehl, Chelsea Stunden, Andreas Lindner, Peter R A Malik, Daniel G Rosenbaum, Oliver Muensterer, Sima Zakani, John Jacob, Shahrzad Joharifard","doi":"10.1016/j.jpedsurg.2025.162232","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2025.162232","url":null,"abstract":"<p><strong>Background: </strong>Inguinal hernia is a common childhood pathology, making inguinal hernia repair (IHR) a key pediatric surgical procedure. Surgical success relies heavily on knowledge of groin anatomy, and both open and laparoscopic approaches require considerable repetition to master. As surgical simulators have been shown to improve performance for other surgical procedures, we developed a combined open and laparoscopic pediatric IHR simulator-named POLISHeR-to train residents, fellows, and practicing surgeons in both types of repair.</p><p><strong>Methods: </strong>A CT scan of a 7-year-old was scaled down to create a virtual 3D model of a 2-year-old using our validated protocol for anatomical modelling. Physical replicas of the pelvis, abdominal wall, aorta, and inferior vena cava were 3D-printed to create a life-size unisex base for open and laparoscopic IHR, while a small mobile unisex base was 3D-printed for open IHR. We recruited six experienced surgeons and trainees to pilot the face validity of POLISHeR.</p><p><strong>Results: </strong>After multiple iterations, we successfully developed a modular 3D-printed simulator for open and laparoscopic IHR. Printing the life-size base cost $331.69 USD, whereas the small base cost $17.54. An open modular cartridge cost $9.92 for females and $14.21 for males, whereas replacement parts cost under $1.30. A laparoscopic modular cartridge cost $6.16 for females and $10.91 for males, whereas replacement parts cost $0.28. Pilot study participants provided encouraging feedback with respect to POLISHER's face validity.</p><p><strong>Conclusions: </strong>Our low-cost simulator holds promise for enhancing training for pediatric IHR. Our next step is to conduct validation trials for trainees and practicing surgeons in both well-resourced and resource-limited settings.</p><p><strong>Level of evidence: </strong>Not applicable.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162232"},"PeriodicalIF":2.4,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515733","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":"Commentary - Social Determinants of Health Influence on Survival in Wilms Tumor, Neuroblastoma, and Hepatoblastoma","authors":"Scott S. Short","doi":"10.1016/j.jpedsurg.2025.162240","DOIUrl":"10.1016/j.jpedsurg.2025.162240","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 4","pages":"Article 162240"},"PeriodicalIF":2.4,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143453119","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":"A Randomized Controlled Trial of Perioperative Education via e-health Technology to Ensure High Quality Equitable Care: One-4-ALL Initiative","authors":"Shannon N. Acker ,&nbsp;Ana Ibarra Meraz ,&nbsp;Samantha N. Wilson ,&nbsp;Claudia Mata ,&nbsp;Marie-France Izere ,&nbsp;Emily Cooper ,&nbsp;Stephanie Fingland ,&nbsp;Hope Simmons ,&nbsp;Elise Van Etten ,&nbsp;Jose Diaz-Miron ,&nbsp;Jill L. Kaar","doi":"10.1016/j.jpedsurg.2025.162235","DOIUrl":"10.1016/j.jpedsurg.2025.162235","url":null,"abstract":"<div><h3>Background</h3><div>Our current system of perioperative education offers variable amounts of information to families, contributing to inequitable care. We hypothesized implementing web-based perioperative education for gastrostomy tube (GT) surgery would be feasible without causing patient harm.</div></div><div><h3>Methods</h3><div>We conducted a randomized controlled trial comparing e-health education to standard education for families of children undergoing GT placement at our center between 6/2023–4/2024. Patients randomized to e-health were assigned preparatory pathways at three times: prior to surgery, prior to hospital discharge, and prior to outpatient follow up. The standard education group received standard perioperative education prior to hospital discharge and at clinic follow up. All participants were asked to complete study surveys at the three timepoints. Clinical outcomes data were collected to assess potential patient harm.</div></div><div><h3>Results</h3><div>We enrolled 62 families: 30 randomized to e-health and 32 to standard education. Demographic factors were similar between groups. Eighty-seven percent of e-health families created an account and viewed the web-based content. Both groups reported high readiness for surgery with 89 % or more reporting GT surgery will benefit my child's health and they were comfortable deciding to elect for GT surgery. The rate of common clinical complications did not differ between groups.</div></div><div><h3>Conclusions</h3><div>An e-health platform to provide perioperative education to families of patients undergoing GT surgery is feasible without negatively impacting patient outcomes. This approach has the potential to improve on our current standard by offering education in a family's preferred language, their own pace, and their own schedule.</div></div><div><h3>Level of evidence</h3><div>Level II – randomized controlled trial.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 4","pages":"Article 162235"},"PeriodicalIF":2.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143403326","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}