Journal of Pediatric Surgery Article Review: January 2022 - APSA Issue

Casey Kelleher is a pediatric surgeon at Mass General for Children in Boston and chair of the APSA Publications Committee

Surgeons have historically been incentivized based on work RVUs, which is important for clinical productivity but does not take advantage of other strengths surgeons have

The concept of academic RVUs was first described approximately 12-13 years ago but did not include how to incentivize people for academic work

Nationwide Children's Hospital implemented a point-based academic RVU system where people accumulate points based on number of publications, presentations, and other academic pursuits

At Akron Children's Hospital under Bob Perry, the bonus structure required the entire group to reach a certain RVU threshold (not individual surgeons) to receive 50% of bonus, with the remaining bonus based on individual project performance

Shahzad Jaharifar is a pediatric surgeon and assistant clinical professor of surgery at BC Children's Hospital in Vancouver, Canada

At Saint Justine Hospital, gastroschisis treatment differed from other institutions by having very low silo use, with pretty much every patient having an attempt at immediate bedside sutureless closure

Before and after protocol implementation at BC Children's, approximately 75% of gastroschisis babies can be closed immediately, whether in the OR pre-implementation with fascial closure or at bedside post-implementation

With silo management, parents look at their newborn's intestines through a silo for 5-6 days and cannot hold their baby until the silo is completely reduced

With immediate gastroschisis closure, if babies are extubated within 48 hours, parents can hold them within 48 hours; if managed without intubation, parents can hold them immediately