European Journal of Pediatric Surgery最新文献

{"title":"Physical Activity Levels in Children with Esophageal Atresia and Congenital Heart Disease: A Comparative Multicenter Study.","authors":"Luisa Maria Frankenbach, Anne-Sophie Holler, Christina Oetzmann von Sochaczewski, Lucas Wessel, Oliver J Muensterer, Jens Dingemann, Anke Widenmann, Paul Helm, Jannos Siaplaouras, Ulrike Bauer, Christian Apitz, Claudia Niessner, Tatjana Tamara König","doi":"10.1055/a-2420-0202","DOIUrl":"10.1055/a-2420-0202","url":null,"abstract":"<p><strong>Aim of the study: </strong> Esophageal atresia (EA) is associated with impaired motor development, cardiopulmonary function, and physical activity (PA). Despite missing scientific evidence, this fact is often attributed to associated congenital heart disease (CHD). The aim of this study was to investigate PA in EA patients without CHD compared with CHD patients and healthy controls.</p><p><strong>Methods: </strong> In this multicenter study, EA patients aged 6 through 17 years were included. Moderate-to-vigorous PA (MVPA, minutes per week) was assessed using the standardized and validated questionnaire Motorik-Modul Physical Activity Questionnaire. EA patients were randomly matched 1:4 for gender and age with patients with CHD (<i>n</i> = 1,262) and healthy controls (<i>n</i> = 6,233). Patients born with both EA and CHD were excluded. Means and 95% confidence intervals (95% CIs) were calculated. To identify associated factors, Spearman's correlation was performed.</p><p><strong>Main results: </strong> Overall, 69 EA patients were matched with 276 CHD patients and 276 controls (57% male, 43% female, mean age 10,3 years, 95% CI: 9.5-11.1). Mean MVPA was reduced in EA (492 minutes, 95% CI: 387-598) and CHD patients (463 minutes, 95% CI: 416-511) compared with controls (613 minutes, 95% CI: 548-679). In subgroup analysis, MVPA was reduced further in females and older age groups with EA and CHD. For EA patients, there was no statistical association between Gross type, current symptoms, surgical approaches, and MVPA.</p><p><strong>Conclusion: </strong> Isolated EA and CHD were associated with reduced PA, especially in females and teenagers. To avoid additional morbidity associated with sedentary behavior, PA should be promoted during follow-up.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"171-179"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142309220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing Efficacy of Regional Analgesia Techniques after Pediatric Inguinal Procedures.","authors":"Yan Li, Fu-Shan Xue, Xin-Yue Li","doi":"10.1055/a-2324-1262","DOIUrl":"10.1055/a-2324-1262","url":null,"abstract":"","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"255"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140916987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Collaborative Efforts in Pediatric Surgery: Lessons from European Randomized Controlled Trials.","authors":"Anne-Fleur R L van Hal, Sara Roman Galdran, Rene M H Wijnen, Judith Leyh, Martin Lacher, John Vlot, Omid Madadi-Sanjani","doi":"10.1055/a-2596-3857","DOIUrl":"https://doi.org/10.1055/a-2596-3857","url":null,"abstract":"<p><p>Conducting multicenter randomized controlled trials (RCTs) in pediatric surgery for rare congenital anomalies presents unique challenges, including low patient recruitment, complex regulatory landscapes, and variability in care standards. This paper reflects on the experiences and lessons learned from the MUC-FIRE and STEPS-EA trials, supported by the European Reference Network for Rare Inherited and Congenital Anomalies (ERNICA), to provide guidance for future studies.A retrospective review was conducted on the design and execution of these trials, focusing on team composition, endpoint selection, patient recruitment strategies, regulatory compliance, and adaptive methodologies. Insights were derived from study protocols, monitoring reports, and the authors' experiences.Key factors contributing to trial success included multidisciplinary collaboration, leveraging existing research networks, and defining clear, measurable endpoints. Challenges such as recruitment delays, regulatory hurdles, and variations in care were mitigated through flexible protocols, proactive amendments, and stakeholder engagement. The COVID-19 pandemic amplified these difficulties, necessitating innovative strategies and extended timelines.The MUC-FIRE and STEPS-EA trials underscore the critical importance of international collaboration, adaptive strategies, and patient-centered approaches in overcoming the complexities of multicenter RCTs. Lessons from these experiences can inform the design and implementation of future trials, ultimately enhancing evidence generation and improving outcomes for children with rare congenital anomalies.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"European Paediatric Surgeons' Association Consensus Statement on the Management of Giant Omphalocele.","authors":"Amulya K Saxena, Romilly K Hayward, Annika Mutanen, Ayman Goneidy, Harmit Ghattaura, Ramon Gorter, Rene Weijnen, Richard Keijzer, Tutku Soyer","doi":"10.1055/a-2590-5592","DOIUrl":"https://doi.org/10.1055/a-2590-5592","url":null,"abstract":"<p><p>Giant omphalocele management had not reached a consensus from the pediatric surgical perspective regarding conservative treatments, surgical approaches, and clinical outcomes. This topic was therefore selected for the 2023 Consensus Session of the European Paediatric Surgeons' Association (EUPSA).Literature review was conducted by seven EUPSA members, guided by a set of predefined areas relating to the management of giant omphalocele: (1) conservative management, (2) surgical management, and (3) outcomes. Members were assigned to specific topics, with discrepancies resolved through structured group discussion and further literature review. Consensus was reached through unanimous agreement among the contributing members. Each topic was presented with available evidence to congress participants. Comments from participants were accounted to formulate the final consensus statement.Giant omphalocele is appropriately defined as viscero-abdominal disproportion preventing primary closure. Regarding (1) <i>conservative management</i>, the \"paint and wait\" approach is recommended when anatomical constraints or high surgical risk preclude primary closure. Common painting agents include povidone-iodine and silver sulfadiazine, with Manuka honey gaining interest, though consensus on dosing, duration, and complications remains unclear. With regards to (2) <i>surgical management</i>, early closure favors biological meshes, while delayed closure appears most effective using native tissues. High mortality in delayed patch closure likely reflects a population with the most severe defects. Finally, (3) <i>outcomes</i> highlights key prognostic factors including chromosomal abnormalities, cardiac defects, and low birth weight, which may guide counseling, screening, and treatment. Limited data on ruptured omphalocele indicates towards increased mortality, necessitating prompt intervention. Complications following management are relatively rare and typically intervention-related, underscoring the need for long-term, multidisciplinary follow-up.A consensus statement on the management of giant omphalocele was developed based on current evidence and peer practice, though imitations relating to a scarcity of high-level evidence and significant heterogeneity across studies should be acknowledged. Despite these constraints, this consensus statement provides evidence-based guidance to support pediatric surgeons in informed decision-making for this pathology.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Retrospective Assessment of Soft Tissue Interposition during Redo Surgery for Postoperative Hypospadias Repair-Related Complications.","authors":"Yuichiro Miyake, Shogo Seo, Junya Ishii, Masahiro Takeda, Yuta Yazaki, Takanori Ochi, Go Minano, Hiroyuki Koga, Geoffrey J Lane, Atsuyuki Yamataka","doi":"10.1055/a-2590-5767","DOIUrl":"10.1055/a-2590-5767","url":null,"abstract":"<p><p>To evaluate two established soft tissue interposition techniques used during redo surgery for selected posturethroplasty complications of hypospadias surgery.Patients with complications who had interposition of scrotal fat, tunica vaginalis fascia, or external spermatic fascia identified from all hypospadias patients presenting to a single institute treated by a single surgeon between 2003 and 2019 (<i>n</i> = 217) were reviewed retrospectively. Urethrocutaneous fistula repair and minor cosmetic corrections were excluded.Eight cases had 10 complications: residual penile curvature > 30 degrees (<i>n</i> = 5), urethral diverticulum > 15 mm (<i>n</i> = 3), urethral dehiscence (<i>n</i> = 1), and urethral stricture (<i>n</i> = 1). All were Japanese. Hypospadias was perineal/penoscrotal (<i>n</i> = 7) or midshaft (<i>n</i> = 1). Initial procedures performed in infancy were single-stage urethroplasty (<i>n</i> = 4) or multistage urethroplasty (<i>n</i> = 4). Ages at first soft tissue interposition during redo single-stage urethroplasty (<i>n</i> = 1) or multistage urethroplasty (<i>n</i> = 7; two-stage: <i>n</i> = 4, three-stage: <i>n</i> = 3) ranged from 4.2 to 46.5 years old. All had their neourethras covered and four also had their scarred urethral plates reinforced laterally. There have been no complications during a mean of 5.6-year follow-up after the last procedure (range: 3.4-8.3 years) and all expressed satisfaction with cosmetic and functional outcomes including standing urination. Tissues for interposition were harvested easily without injuring surrounding structures such as the vas deferens or testicular vessels, even though previous surgery had caused extensive adhesions and structural disruption.Unlike reinforcement with tunica dartos fascia, soft tissue interposition specifically boosts tissue thickness and perfusion at the operative site during redo surgery for technically challenging posturethroplasty complications.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thoracoscopic Repair of Recurrent CDH is Associated with a Significantly Lower Complication Rate and Shorter ICU and Hospital Stay: A Prospective, Propensity Score-Matched Analysis.","authors":"Lydia Beck, Christel Weiss, Christoph Mohr, Richard Martel, Michaela Klinke, Jin Rhee, Katrin Zahn, Thomas Schaible, Michael Boettcher, Julia Elrod","doi":"10.1055/a-2590-5512","DOIUrl":"https://doi.org/10.1055/a-2590-5512","url":null,"abstract":"<p><p>Congenital diaphragmatic hernia (CDH) is a malformation that significantly impacts neonatal morbidity and mortality. Recurrence after surgical repair remains a potentially life-threatening long-term complication. Conventionally, recurrent CDH has been managed through open surgery. However, thoracoscopic repair (TR) represents a novel alternative for recurrent CDH as it has reduced the length of hospital stay and mortality rate in the primary CDH repair.A prospective, propensity score-matched analysis was conducted on pediatric patients who underwent recurrent CDH repair at the University Hospital Mannheim between 2013 and 2023, to compare the outcomes of laparotomy versus TR. Patients were categorized based on the surgical technique employed. Comparative analysis, including propensity scoring, encompassed outcome measures such as duration of ICU and hospital stays, rate of complications, and operative duration.In total, 703 patients were treated for CDH, of whom 69 children underwent laparotomy (56) or TR (16) for CDH recurrence. After propensity score matching, TR group demonstrated a significantly shorter duration of surgery (178 [93-311] versus 225 [113-450] min, <i>p</i> = 0.042), reduced ICU stay (0 [0-10] versus 1 (0-69) days, <i>p</i> = 0.011), and decreased overall hospital stay (6 [3-34] versus 12 [7-40] days, <i>p</i> = 0.001). Moreover, the postoperative complications were significantly lower in the TR group (21.43% versus 73.68%, <i>p</i> = 0.003).TR for recurrent CDH repair is associated with shorter operation times, reduced ICU and overall hospital stays, and fewer complications compared with laparotomy. These findings suggest that TR may be preferable for the management of recurrent CDH, warranting larger randomized controlled studies to confirm the long-term safety and efficacy of this approach.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomical Correction and Early Outcomes of One-step Ventral and Dorsal Proctoplasty in Girls with Low Anorectal Malformations.","authors":"Nicolas Vinit, Mathilde Glenisson, Justine Leroy, Sabine Sarnacki, Célia Crétolle, Sylvie Beaudoin","doi":"10.1055/a-2590-5697","DOIUrl":"https://doi.org/10.1055/a-2590-5697","url":null,"abstract":"<p><p>Rectoperineal fistula (RPF) and rectovestibular fistula (RVF) are the most common forms of low anorectal malformations (ARMs) in girls, and lead to difficult stooling, thus demanding early surgical correction. This study's aim was to assess early outcomes associated with one-step ventral and dorsal proctoplasty in RPF/RVF.All female infants who consecutively underwent one-step proctoplasty for RPF/RVF at our institution (2012-2022) were retrospectively included. Reviewed data included: age at procedure, congenital anomalies, fistula location, preoperative symptoms, intraoperative findings, operative time, postoperative complications, and bowel functional outcome. Success of the technique, defined as spontaneous bowel movement at last follow-up without anal dilation, was assessed. Secondary outcomes included resolution of preoperative symptoms, and Krickenbeck score and fecal continence in girls older than 3 years at last follow-up. No preoperative bowel preparation was necessary.None of the 77 included girls (median age at surgery: 3.2 months (2.3-7.3)) had prior colostomy. In every case, intraoperative findings included: ventral defect of the external anal sphincter, and abnormal attachment of the bulbospongiosus muscles to the fistula and posterior ledge, thus justifying both ventral and dorsal reconstructions. The median operative time was 34 min (27-38), and the median hospital stay was 2 days (2-3). Limited ventral skin dehiscence was the most common postoperative complication (31%), with limited effect on clinical outcome (one secondary anal stricture). No child required secondary colostomy or revision anoplasty. One child underwent secondary pull-through due to persistent megarectum. Preoperative symptoms resolved in 98% of cases. After a median follow-up of 27.6 months (9.8-48.3), all girls had spontaneous bowel movement and 21% had grade-2 constipation. The technique was successful in 97% of cases (two anal strictures treated with dilations).RPF/RVF in female share abnormal anatomical characteristics. One-step ventral and dorsal proctoplasty allows precise anatomical correction of low ARM in girls.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Efficacy of Cryoanalgesia With and Without Regional Nerve Blocks for Postoperative Pain in Nuss Procedure: A Systematic Review and Meta-Analysis.","authors":"Kristine Santos, Karen Aoke, Vrushali Shelar, Mario Lira, Felipe Passos","doi":"10.1055/a-2596-3791","DOIUrl":"https://doi.org/10.1055/a-2596-3791","url":null,"abstract":"<p><strong>Background: </strong>Cryoanalgesia (CA) has shown promise in managing postoperative pain in patients undergoing the Nuss procedure for pectus excavatum but has a delayed onset. Adjunctive regional anaesthesia, such as nerve blocks (NB), may enhance early analgesia. Our meta-analysis aims to evaluate the comparative efficacy of combining CA with NB (CNB) versus CA alone.</p><p><strong>Methods: </strong>A literature search was conducted focusing on studies that compared CNB and CA alone for postoperative pain management following the Nuss procedure. RevMan 8.13.0 was used to calculate effect estimates reported as mean differences (MD), with 95% confidence intervals (CI).</p><p><strong>Results: </strong>Three observational studies comprising a total of 161 patients were included. Of these, 71 patients (44.1%) received the combined treatment of CNB. CNB was associated with significantly shorter hospital stays [MD -0.51 days; 95% CI -0.80 to -0.21; p < 0.05; I² = 0%], reduced postoperative opioid consumption [MD -0.74 OME/kg; 95% CI -1.16 to -0.32; p < 0.05; I² = 35%], and lower postoperative pain scores on postoperative day (POD) 3 [MD -1.03 points; 95% CI -1.76 to -0.30; p < 0.05; I² = 0%]. No significant differences were observed in operative duration or postoperative pain scores on POD 0, POD 1 and POD 2.</p><p><strong>Conclusion: </strong>CNB may be associated with improved postoperative outcomes compared to CA alone in patients undergoing the Nuss procedure. However, given the small sample size and the observational nature of the included studies, further high-quality randomised controlled trials are needed to validate these findings and inform clinical practice.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Low-Pressure CO2 Insufflation on Cerebral and Splanchnic Oxygenation in Neonates Undergoing Laparoscopic Pyloromyotomy.","authors":"Silvia Ceccanti, Alice Cervellone, Oscar Mazzei, Maria Vittoria Pesce, Denis A Cozzi","doi":"10.1055/a-2561-0523","DOIUrl":"https://doi.org/10.1055/a-2561-0523","url":null,"abstract":"<p><p>Pathophysiological effects of abdominal CO₂ insufflation on cerebral and splanchnic oxygenation in neonates and infants undergoing laparoscopy remain poorly investigated. We investigated laparoscopic pyloromyotomy as a paradigm to determine such changes in this specific population.Single-center, prospective cohort of 28 infants undergoing laparoscopic pyloromyotomy at the mean age of 30.9 ± 10.6 days. The pneumoperitoneum was set at 6 to 8 mmHg. Regional cerebral oxygen saturation (cSO₂) and splanchnic oxygen saturation (sSO₂) were measured by near-infrared spectroscopy. End-tidal carbon dioxide (EtCO₂) levels, heart rate, body temperature, systemic blood pressure, and urine output were also recorded. Data (mean ± SD) were collected intraoperatively at 0, 15, and 30 minutes and compared to baseline values for each patient using the <i>t</i>-test.A significant decrease in cSO₂ was recorded only at the beginning of surgery, while sSO₂ significantly decreased from 15 intraoperative minutes (-7.1% ± 7.2; <i>p</i> = 0.0009) until the end of insufflation, followed by an increasing trend, although still below the baseline values (-6.5% ± 11.2; <i>p</i> = 0.01). EtCO₂ increased significantly from the initial 15 intraoperative minutes, reaching a maximum of 42.6 ± 8.9 mmHg at 30-minute intervals. Urine output significantly decreased within the first 4 postoperative hours.Laparoscopic pyloromyotomy using low-pressure CO₂ insufflation (6-8 mmHg) maintains stable cerebral oxygenation in neonates and infants, while splanchnic oxygenation and urine output experience temporary, reversible reductions. These findings suggest that low-pressure pneumoperitoneum is a safe and effective approach in neonatal laparoscopy, with minimal oxygenation and metabolic risks.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The European Pediatric Surgical Audit: Improving Quality of Care in Rare Congenital Malformations.","authors":"Nadine M Teunissen, Daniel Rossi, Michel W Wouters, Simon Eaton, L W Ernest van Heurn, Rene Wijnen","doi":"10.1055/a-2551-2056","DOIUrl":"https://doi.org/10.1055/a-2551-2056","url":null,"abstract":"<p><p>Since 2019, the European Pediatric Surgical Audit (EPSA) has been the official registry of the European Reference Network for Inherited and Congenital Anomalies (ERNICA). The primary aim of this prospective patient registry is benchmarking (quality of) care for patients with rare congenital malformations throughout Europe. Data collected comprise baseline, treatment, and outcome variables, permitting calculation of disease-specific, hospital-level quality indicator results reflecting between-hospital variation. This practice and outcome variation is fed back as actionable information to clinicians on a web-based, real-time dashboard to help focus local and central improvement initiatives. Secondly, realizing joint research initiatives with quality improvement purposes through secondary data use will increase our knowledge of these rare conditions and optimize care. Currently, 27 hospitals in 15 European countries have connected to this unique, European-wide audit. Henceforward, the focus will be on the further expansion of hospitals and diseases, as EPSA aspires to become all-encompassing, including all European patients with congenital malformations.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}