StayCurrentMD · Journal of Pediatric Surgery Article Review: 4th Quarter (Oct-Dec) 2024
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Podcast18 min·Published Feb 2025

Journal of Pediatric Surgery Article Review: 4th Quarter (Oct-Dec) 2024

With Dr. Tony Escobar & Dr. Adi Fahy & Dr. Mikko Pakarinen & Dr. Anna Flirt van Gaal · hosted by Dr. Em Gootee

Chapter 1 of 4 · Evidence & Research

Locum tenens guidelines

Locum Tenens in Pediatric Surgery: APSA Position Statement and Practice Guidelines

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What the experts said17 expert statements · 6 host summaries
There was no regulation or recommendations for practicing pediatric surgeons on how to engage with the locum tenens market prior to APSA's guidelines
GuidelineTony Escobar
Locum tenens agencies facilitate attainment of state medical license, privileges and credentials at hiring institutions, and negotiate surgeon compensation including travel and lodging
ClinicalAdi Fahy
APSA is developing a breakout group to provide ongoing support to pediatric surgeons working in locum tenens roles
GuidelineTony Escobar
Tracheomalacia in esophageal atresia patients causes respiratory issues including stridor, wheezing, harsh barking cough, and lower respiratory infections
ClinicalAnna Flirt van Gaal
In up to a third of esophageal atresia cases, tracheomalacia can lead to recurrent respiratory insufficiency and severe respiratory events
EpidemiologicalAnna Flirt van Gaal
There is no consensus on tracheal assessment during diagnosis of esophageal atresia
GuidelineAnna Flirt van Gaal
In the Dutch center, patients undergo preoperative tracheal bronchoscopy as standard of care, but postoperative bronchoscopy is performed only when clinically indicated
ClinicalAnna Flirt van Gaal
The 50% sensitivity finding suggests it might be advisable to avoid primary therapeutic intervention at time of esophageal atresia repair and only treat patients who develop symptoms
OpinionMikko Pakarinen
A prospective study with standardized assessments and larger patient groups is needed to clarify the role of bronchoscopy in tracheomalacia assessment
OpinionAnna Flirt van Gaal
During the pandemic, limited hospital beds led to consideration of same-day discharge for gastrostomy patients to optimize resource use
ClinicalBen Hamm
NSQIP pediatric registry includes more than 150 participating hospitals across 44 states and 7 countries
EpidemiologicalPablo Laje
The study identified approximately 6000 pediatric patients who underwent elective gastrostomy tube placement from 2017 to 2021 in the NSQIP database
EpidemiologicalJohn Woodward
About 5% of gastrostomy patients were discharged the same day as surgery
EpidemiologicalJohn Woodward
Same-day discharge rates increased from 2.7% in 2017 to 6.3% in 2021, representing a doubling of the rate
EpidemiologicalJohn Woodward
There were no differences in readmission or reoperation rates between same-day discharge and 1-2 day discharge cohorts
ClinicalJohn Woodward
Implementing same-day discharge requires major process changes including advance family education, nutrition partnership for feeding plans, and setup of pumps and supplies
ClinicalBen Hamm
From every point of view, one less day in hospital is a win for the patient, family, and hospital
OpinionPablo Laje
The Dutch study evaluated close to 80 esophageal atresia patients comparing preoperative to postoperative bronchoscopy findings
Host summaryMikko Pakarinen summarizing the discussion · not cited in answers
Definite tracheomalacia was defined as almost complete or complete collapse of the airway on bronchoscopy
Host summaryAnna Flirt van Gaal summarizing the discussion · not cited in answers
Suspected tracheomalacia was defined based on symptoms including barking cough and upper airway infections
Host summaryAnna Flirt van Gaal summarizing the discussion · not cited in answers
The sensitivity and specificity of preoperative tracheal bronchoscopy for predicting tracheomalacia outcomes were around 50%
Host summaryAnna Flirt van Gaal summarizing the discussion · not cited in answers
Many centers typically keep children in hospital for one to two days after elective laparoscopic gastrostomy tube placement to allow time for family education, feeding plan setup, and tolerance verification
Host summaryPablo Laje summarizing the discussion · not cited in answers
The study excluded patients who came to hospital from emergency room or were transferred from other facilities, as well as those who remained hospitalized more than 2 days
Host summaryPablo Laje summarizing the discussion · not cited in answers