Journal of pediatric surgery最新文献

{"title":"Factors associated with referrals after substance use screening in adolescent trauma patients.","authors":"Jenna S Lee, Ryan G Spurrier, Shadassa Ourshalimian, Jordan M Rook, Rabab Barq, Banan Otaibi, Nikhita Datar, Emma Kirkpatrick, Eric Roseman Lcsw, Pradip P Chaudhari, Lorraine I Kelley-Quon","doi":"10.1016/j.jpedsurg.2026.163461","DOIUrl":"10.1016/j.jpedsurg.2026.163461","url":null,"abstract":"<p><strong>Purpose: </strong>Substance use screening for injured adolescents is recommended but not required by the American College of Surgeons and little is known about referral for substance use support services. This study aimed to identify factors associated with referral to substance use support services among injured adolescents.</p><p><strong>Methods: </strong>This retrospective cohort study examined injured adolescents 12-17y at a level I pediatric trauma center from January 2021-June 2024. Sociodemographic and clinical data were abstracted from electronic medical record and trauma registry. Screening included receipt of biochemical tests (urine toxicology and blood alcohol test) and receipt of a Screening, Brief Intervention, and Referral to Treatment (SBIRT). Factors associated with referral after positive screening were analyzed using bivariate and multivariable logistic regressions.</p><p><strong>Results: </strong>Of 683 injured adolescents, 434 (63.4%) underwent substance use screening and 88 (20.3%) had at least one positive substance use screening result. Only 32 (36.4%) adolescents with positive screening results had a documented referral to substance use support services. In bivariate analysis, cannabis and alcohol use were significantly associated with referrals (p < 0.05). In multivariable logistic regression analysis, positive alcohol test was significantly associated with higher odds of referral (AOR 4.14, 95% CI: 1.49-11.53), whereas demographic or injury-related characteristics were not.</p><p><strong>Conclusion: </strong>Substance use screening among injured adolescents remains underutilized. Referral for treatment remains infrequent, even for those with a positive drug screen. These findings highlight a critical gap in connecting the high-risk injured adolescents to appropriate treatment and support services.</p><p><strong>Level of evidence: </strong>Level IV.</p><p><strong>Study type: </strong>Retrospective cohort.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163461"},"PeriodicalIF":2.3,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990369","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":"Minimally invasive surgical treatment of different types of hyperinsulinism.","authors":"Yao Wei, Zhang Miaoying, Li Kai, Liu Baihui, Luo Feihong, Dong Kuiran","doi":"10.1016/j.jpedsurg.2026.163473","DOIUrl":"10.1016/j.jpedsurg.2026.163473","url":null,"abstract":"<p><strong>Background: </strong>Congenital hyperinsulinism of infancy (CHI) is a rare and genetically heterogeneous disorder that often requires surgical intervention when medical therapy fails. Distinct pathological subtypes of CHI necessitate different surgical strategies. Minimally invasive surgery has increasingly been considered a safe and feasible approach for these patients. This study aimed to evaluate the outcomes of minimally invasive surgery for different CHI subtypes at our center.</p><p><strong>Methods: </strong>We conducted a retrospective single-center review of 110 patients with CHI who underwent minimally invasive surgery between 2011 and 2024.</p><p><strong>Results: </strong>Pathological subtypes comprised 45 focal, 64 diffuse, and one atypical case. 18F-DOPA PET/CT was performed in 97 patients, demonstrating a diagnostic concordance rate of 94.8%. Conversion to open surgery was required in three patients (two focal and one diffuse) because of intraoperative bleeding, whereas the remaining 107 procedures were completed minimally invasively, including eight robotic-assisted operations (five focal and three diffuse). Among patients with focal CHI, 91.1% achieved cure without postoperative medication. In diffuse disease, near-total pancreatectomy resulted in a higher cure rate than subtotal resection (66.7% vs. 51.2%) but was associated with an increased incidence of postoperative hyperglycemia and common bile duct injury. Two patients required reoperation because of persistent hypoglycemia.</p><p><strong>Conclusion: </strong>Minimally invasive surgery is a safe and feasible treatment for CHI, providing outcomes comparable to open surgery. Focal CHI is associated with excellent postoperative outcomes and may benefit from earlier surgical intervention. For diffuse CHI, approximately 95% pancreatectomy may achieve satisfactory glycemic control while balancing the risk of postoperative complications.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163473"},"PeriodicalIF":2.3,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955946","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":"Donut leave it to chance: Frozen circumferential biopsies reduce rates of transition zone pull-through.","authors":"Megan A Read, Hendt P Versteegh, Syed F Hussaini, Josh Bricker, Ihab Halaweish, Alessandra C Gasior, Vinay Prasad, Richard J Wood, Liese C C Pruitt","doi":"10.1016/j.jpedsurg.2026.163475","DOIUrl":"10.1016/j.jpedsurg.2026.163475","url":null,"abstract":"<p><strong>Purpose: </strong>This study evaluates the role of intraoperative frozen-section circumferential biopsies (\"donuts\") in preventing transition zone (TZ) pull-through (PT) in patients with Hirschsprung disease (HSCR).</p><p><strong>Methods: </strong>We performed a single-institution retrospective review of intraoperative and final pathology reports for all PTs between 2020 and 2026 in which a frozen-section donut was obtained from planned anastomotic site based on previously confirmed normal full-thickness biopsy. If the initial donut was abnormal, additional proximal donuts were obtained. Donuts were considered normal when ganglion cells were present circumferentially, and fewer than two hypertrophic submucosal nerves were observed per high-power field.</p><p><strong>Results: </strong>Frozen-section donuts were sent for intraoperative consultation in 134 PTs. Fourteen cases required two donuts, and two cases required three; among these 16 cases, 14 were due to abnormal pathology, and two for technical reasons. Final pathology was concordant with frozen-section findings in 130 patients (97.0%). Additional donuts prevented TZ PT in 13 patients (9.6%). Two patients (1.5%) had circumferential ganglion cells with hypertrophic nerves on final pathology despite normal frozen-section results. Non-circumferential ganglion cells were identified in two patients: one was accepted after two abnormal donuts and discussion with family; the other resulted from inaccurate donut processing.</p><p><strong>Conclusion: </strong>In this series, frozen-section circumferential biopsies reduced the incidence of TZ in PT, with only 3.0% of patients demonstrating TZ on final pathology and an additional 9.6% prevented intraoperatively. Routine use of this technique, alongside ongoing improvements in pathologic processing, enhances intraoperative decision-making and may contribute to safer, more effective PT procedures for HSCR.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163475"},"PeriodicalIF":2.3,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955909","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":"Monitoring NIH support for surgical clinical trials in pediatrics in a changing funding landscape; 2020-2025.","authors":"Ansh Goyal, Justin Ryder, Mehul V Raval, Susanna A McColley","doi":"10.1016/j.jpedsurg.2026.163469","DOIUrl":"10.1016/j.jpedsurg.2026.163469","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163469"},"PeriodicalIF":2.3,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945047","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":"Toward genomics-guided, AI-Assisted robotic ligation of tracheoesophageal fistula in VACTERL-Associated esophageal atresia: A perspective.","authors":"Minahil Ali, Daniyal Naqvi","doi":"10.1016/j.jpedsurg.2026.163440","DOIUrl":"10.1016/j.jpedsurg.2026.163440","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163440"},"PeriodicalIF":2.3,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944997","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":"Building local capacity for bowel management in low resource settings: Program sustainability and expansion.","authors":"Marissa Ray, Stephen Trinidad, Denis Oluka, Saidat Nabiyiki, Sandra Akatukunda, Ivan Nuwagaba, Maria Obermeyer, Meera Kotagal, Felix Oyania","doi":"10.1016/j.jpedsurg.2026.163446","DOIUrl":"10.1016/j.jpedsurg.2026.163446","url":null,"abstract":"<p><strong>Introduction: </strong>Congenital colorectal conditions including anorectal malformations (ARM) and Hirschsprung's disease (HD) can cause chronic issues with constipation and incontinence leading to reduced quality of life. Bowel management programs (BMP) are critical to addressing these challenges. There is a paucity of literature on intermediate-term outcomes of BMPs for patients in low and middle-income countries (LMICs).</p><p><strong>Methods: </strong>In June 2022, a BMP for patients with ARM or HD was initiated at a tertiary referral hospital in Mbarara, Uganda. Local staff were trained by visiting staff with experience in organized bowel management and collaboratively managed a pilot cohort. Patients began with a 2-week program with imaging, clean-out, titration of enema components by nursing staff, and family education. Caregivers completed forms at the start and end of the program and via phone call during periodic follow-ups. Local staff then continued to run the program and enroll additional patients. A Cochran Armitage test was performed to determine association between adherence to program and reduction in involuntary bowel movements (BM).</p><p><strong>Results: </strong>From June 2022-June 2025, 53 patients have enrolled in the BMP, including 12 patients in the pilot joint US-Ugandan led cohort. Intake forms were available for 44 patients. Median age at presentation was 3.5 years (IQR 2-5.5 years), 70% were male, and the most common diagnosis was ARM (43.2% ARM, 25% HD, 2.3% idiopathic constipation, 29.5% unknown). Around half of patients were reached on follow-up (n = 28, 52%). Median number of days at final follow-up was 433.5 (IQR 390.5-694) with 2 (IQR 1-3.75) recorded follow-ups per patient. Overall, patients demonstrated an adherence rate of 74%. Adherence to the program was associated with greater reduction in both day (p = 0.013) and night (p = 0.012) involuntary BMs. Comparing the pilot and expansion cohorts, there was no difference in final regimen (pilot cohort: 75% enema, 16.7% laxatives, 8.33% discharged vs expansion cohort: 68.4% enema, 15.8% laxatives, 15.7% discharged; p = 0.9) and soiling outcomes with sustained reduction in day and night BMs at 2 weeks and on final follow-up.</p><p><strong>Conclusion: </strong>Patients had sustained decreased rates of incontinence and similar rates of voluntary BMs at intermediate term follow-up, compared to two weeks post-program enrollment. Patients enrolled and managed exclusively by the local Ugandan team had similar outcomes to the pilot cohort, indicating that short term targeted education and co-management of patients in LICs can successfully serve as the foundation for development of local capacity for bowel management programs.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163446"},"PeriodicalIF":2.3,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944900","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":"Quantitative indocyanine green fluorescence angiography for anastomotic perfusion assessment during thoracoscopic esophageal atresia repair: A two-phase study.","authors":"E A Breuking, H G M Vaassen, J E Hut, E M B P Reuling, J W Verweij, M J Witvliet, M Y A Lindeboom, S H A J Tytgat, J Ruiterkamp","doi":"10.1016/j.jpedsurg.2026.163468","DOIUrl":"10.1016/j.jpedsurg.2026.163468","url":null,"abstract":"<p><strong>Introduction: </strong>Thoracoscopic esophageal atresia (EA) repair is associated with high rates of anastomotic complications. Impaired perfusion may contribute to poor healing. Quantitative indocyanine green fluorescence angiography (ICG-FA) may enable objective anastomotic perfusion assessment. This study describes the implementation of quantitative ICG-FA during thoracoscopic EA repair and explores its association with anastomotic complications (leakage and/or stenosis).</p><p><strong>Methods: </strong>A two-phase study was conducted, including patients undergoing fluorescence-guided thoracoscopic EA repair according to a standardized protocol between February 2024 and February 2026. Phase one consisted of retrospective qualitative and exploratory quantitative assessment. Phase two consisted of prospective quantitative assessment. Fluorescence recordings were postoperatively analyzed for time-to-peak (TTP), normalized peak slope (NPS) and hypoperfusion width.</p><p><strong>Results: </strong>Twenty-nine patients underwent fluorescence-guided thoracoscopic EA repair. No ICG-related adverse events occurred. Anastomotic complications occurred in 17 patients (58.6%). Qualitative assessment demonstrated limited concordance with outcome (62.1%). In the prospective cohort, postoperative quantitative assessment was feasible in 13 patients (86.7%). Patients with anastomotic complications demonstrated a significantly larger hypoperfusion width at the anastomotic site (5 mm vs 2 mm, p = 0.019). No significant differences were observed in TTP and NPS.</p><p><strong>Conclusion: </strong>Quantitative anastomotic perfusion assessment using ICG-FA is feasible in thoracoscopic EA repair. Quantitative analysis can provide objective, comparable and reproducible information beyond visual interpretation but requires strict adherence to standardized protocols. Anastomotic complications may be, at least partially, associated with (pre-existent) local perfusion deficits rather than mechanical factors (e.g. tension) only. Future research to validate quantitative parameters may contribute to optimized risk stratification and surgical decision-making.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163468"},"PeriodicalIF":2.3,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945005","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":"Surgical outcomes for pediatric patients with neurodevelopmental disorders and inflammatory bowel disease.","authors":"Tiffany Y Cheng, Su Yeon Lee, Gabriella Sehres, Jamie E Anderson, Jonathan E Kohler","doi":"10.1016/j.jpedsurg.2026.163460","DOIUrl":"10.1016/j.jpedsurg.2026.163460","url":null,"abstract":"<p><strong>Introduction: </strong>Neurodevelopmental disorders (NDD) are associated with inflammatory bowel disease (IBD). For children with NDD, difficulties with assessment and communication can complicate care. We sought to define the perioperative outcomes for children with NDD and IBD who undergo colectomy.</p><p><strong>Methods: </strong>Using the National Surgical Quality Improvement Pediatric (NSQIP-P) database from 2019 to 2023 we identified children with IBD who underwent total or partial colectomy. NDD diagnosis was identified using the NSQIP-P variable for \"developmental delay\". Outcomes were analyzed using Fisher's exact test for categorical outcomes and Rank Sum test for contiguous variables, followed by multivariable logistic regression.</p><p><strong>Results: </strong>Of 1978 pediatric patients who underwent a colectomy, 71 (3.6%) were identified as having NDD. NDD patients had longer average hospital lengths of stays (LOS) prior to their operation (9.66 vs. 3.71 days, p = 0.0045) but had no difference in LOS post-operatively. They required more nutritional support pre-operatively (aOR 2.30, 95% 1.38-3.83, p = 0.001) but were not more likely to be discharged on total parenteral nutrition (aOR 2.2, 95% CI 0.9-5.0, p = 0.07). Patients with NDD were more than eight times as likely to be diagnosed with pneumonia postoperatively (aOR 8.84, 95% CI 2.15-36.29, p = 0.003). Other findings that were significant on univariate analysis did not persist after multivariable analysis.</p><p><strong>Conclusion: </strong>NDD patients have different hospital courses compared to their non-NDD counterparts when undergoing colectomies for IBD. However, this study is limited by the broad NSQIP definition of NDD. Further research would benefit from granularity of NDD diagnoses and perioperative variables in national databases.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163460"},"PeriodicalIF":2.3,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148930151","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":"Organ system-specific trends in congenital anomaly admissions following Texas senate bill 8.","authors":"Mary Elizabeth Guerra, Kathleen E Hosek, Sarah E Peiffer, Shannon Larabee, Alice King","doi":"10.1016/j.jpedsurg.2026.163462","DOIUrl":"10.1016/j.jpedsurg.2026.163462","url":null,"abstract":"<p><strong>Background: </strong>Following implementation of Texas Senate Bill 8 (SB8), which bans abortions after approximately six weeks of gestation, increases in infant admissions have been observed, particularly among those with congenital anomalies.</p><p><strong>Purpose: </strong>To evaluate changes in admissions and operative needs among newborns with congenital anomalies in Texas, stratified by organ system.</p><p><strong>Methods: </strong>Retrospective analysis of the Texas Inpatient Public Use Data File, comparing pre- (Q1 2020 - Q2 2021) and post-SB8 (Q3 2021 - Q2 2024). Interrupted time series analyses assessed trends in total and operative admissions. Mortality was compared across one-year pre- and post-SB8 periods using Fisher's exact tests.</p><p><strong>Results: </strong>Operative congenital anomaly admissions declined prior to SB8 (-86.5 admissions/year) but increased post-SB8 (+32.3 admissions/year). Operative needs varied by organ system; digestive anomalies had the highest operative intensity (53.6%). Temporal trends were heterogeneous, with variable changes across systems including declines in circulatory anomalies. Significant mortality changes included increased overall and operative mortality in circulatory anomalies (overall: P < 0.0001; operative: P < 0.0001), increased overall mortality in respiratory anomalies (P = 0.030), and decreased non-operative mortality in nervous system anomalies (P = 0.023), although most rates were stable.</p><p><strong>Conclusions: </strong>Newborn congenital anomaly admissions increased in the period following SB8, coinciding with a reversal of declining operative volumes. Operative intensity and temporal trends varied substantially by organ system. Mortality remained low overall but increased notably in circulatory and respiratory categories. These findings underscore the importance of organ system-specific evaluation of outcomes following reproductive policy changes.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163462"},"PeriodicalIF":2.3,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920146","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":"Operative timing of resection in prenatally diagnosed congenital lung malformations among major children's hospitals in the United States.","authors":"Kyra M Halbert-Elliott, Nicole J Bertaux, Latoya A Stewart, Terry L Buchmiller, Casey M Calkins, April Carlson, Benjamin D Carr, Darrell L Cass, Joseph T Church, Ashly Chimner, Caitlin J Crosier, S Christopher Derderian, Vincent P Duron, Stephen J Fenton, Anthony Ferrantella, Zoe Flyer, Cecilia Gigena-Heitsman, Brian W Gray, Rakesh R Gurrala, Faraz A Khan, Aimee G Kim, Kezlyn Larsen, Jasmine Lee, Inna N Lobeck, Caroline W Maloney, Jooyoung Park, David Partrick, Deion Pena, Tayana A Jean Pierre, Marissa Ray, Jason O Robertson, Branae Rollins, Beth Rymeski, Marisa E Schwab, Jessica K Sims, Linda M Cherney Stafford, Christopher W Snyder, Raphael C Sun, Lauren R Templeton, Sarah A Tracy, Cortnie Vaughn, Peter T Yu, Irving J Zamora, Shaun M Kunisaki","doi":"10.1016/j.jpedsurg.2026.163449","DOIUrl":"10.1016/j.jpedsurg.2026.163449","url":null,"abstract":"<p><strong>Background: </strong>The optimal timing of resection of congenital lung malformations (CLMs) remains controversial. This study evaluated whether postoperative complications and respiratory morbidity differ by age at operative management in children with prenatally diagnosed CLMs.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of patients with a prenatally diagnosed CLM across 19 major children's hospitals in the United States (2016-2023). After excluding neonatal cases, patients undergoing resection were stratified into five groups based on operative age. The primary outcome was 30-day postoperative complications. Secondary outcomes included operative time and length of stay. Statistical comparisons were performed using one-way ANOVA, chi-squared tests, and multivariable logistic regression (p < 0.05).</p><p><strong>Results: </strong>Among 937 patients, there was significant institutional variation in operative age (median range 3-9 months, p < 0.0001). Respiratory symptoms were highest in the 1-3-month cohort (24.2%) and lowest between 3 and 9 months (3.2%, p < 0.0001). Prior pneumonia was more frequent after 12 months (3.9%, p < 0.0001). Operative time (p = 0.80) and hospital length of stay (p = 0.47) were similar across cohorts. Although the 1-3-month cohort had the highest observed complication rate (19.4%), overall complication rates did not significantly differ across age cohorts after adjusting for preoperative respiratory symptoms.</p><p><strong>Conclusion: </strong>In this large multi-institutional study, age at resection was not independently associated with postoperative complication rates. However, the interval between 3 and 9 months of age may represent the clinically preferred window for operative resection given its association with asymptomatic disease. These findings should inform prenatal and preoperative counseling discussions with families.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163449"},"PeriodicalIF":2.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912763","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}