JPS Journal Club: June 2019

Hey guys, so the recent issue of JPS was the AAP issue. What did you like? What did you not like? Givens. The article that I enjoyed uh from this issue was combining a couple of different hot topics in pediatric surgery right now. Um one of them was the enhanced recovery protocols after uh colorectal and upper GI surgery. Um and then uh combining that with opioid reduction as well. Um so this was a follow up for a previous enhanced recovery protocol study. Um but this time instead of just kind of looking at uh length of stay, they were looking at how that affected the amount of opioids prescribed at discharge. And the authors found that even though there was no component of the protocol that uh accounted for discharge opiates, um that there was a significant reduction in the amount of opioids uh prescribed for patients in the ERP pathways. That's great. That's a good study because everyone's been talking about is this really going to work? Uh and it's good to see some actual data. That's great. Kasar, what did you find? So, going with the theme of uh how surgeon uh volumes are affecting patient outcomes and the sustainability of pediatric surgical practice. Uh I picked an article about surgeon volumes and outcomes in pediatric thyroidectomy. And it's something that has been done in the past in adults, but this one is pediatric specific. It's a FIS database study, so it's retrospective, and they found that for total thyroidectomies, there's a statistically significant difference in outcomes between surgeons and hospitals from high volume and low volume uh of cases. And another interesting finding that they had is that they compared uh the outcomes of pediatric surgeons uh versus pediatric ENTs, uh and pediatric surgeons uh had better outcomes with fewer complications overall and then uh subset for graves and for cancer, which is provocative. I know. I I saw that and I was like, ooh, touchy. That'll be interesting to see the reaction to that. All right, Ray, what do you got? So, I uh particularly liked an article by Cunningham and Shaw out of Texas Children's, looking at single visit surgery. Essentially where, you know, you see a patient in clinic, that same day you're operating on them and then they're going home. Um, so previously families loved it. So this study looked at is it financially beneficial? Um, and they found retrospectively over about a year and a half, um that they got reimbursed 100% of the procedures and like 92% of the clinic visit. So a lot of the push back was insurance may not approve it. Um, so making it more convenient may not actually make it financially beneficial for the family. And I just I want to clarify what this is. This is that the patient comes in in the morning Yeah. seen by the surgeon and then they were pre-scheduled to have an operation assuming that the findings were what were expected to have surgery in the afternoon. Um, so overall, it decreases amounts amount of time families are taking off to come in to see us in clinic and it's making our time more efficient, right? It's just you needed umbilical hernia repair. We're going to repair you today and then you're going to go home. Like one shot. So, summarize, Alex, your paper showed that with ERAS implementation, we had a decreased use of opioids. Um, Kasar, your paper showed that high volume uh centers uh for thyroidectomy had better outcomes and also pediatric surgeons had better outcomes. And array, your study showed that single visit surgery uh actually not only is good for patient satisfaction, but actually is financially viable as well. Yep. Is that a good summary? Yeah, I think so. Yeah. Perfect.