BACKGROUND:The effect of indocyanine green (ICG) guidance during laparoscopic Kasai portoenterostomy (Lap-KPE) on intraoperative decision-making and postoperative outcomes remains unclear. This study evaluated whether ICG guidance influences surgical behavior and short-term outcomes. METHODS:Consecutive patients who underwent Lap-KPE between 2010 and 2025 were retrospectively reviewed. JF was defined as a serum total bilirubin level <1.2 mg/dL at any time after surgery. Short-term NLS was assessed at 1 year postoperatively. Operative video recordings were reviewed to identify additional cuts guided by ICG fluorescence at the porta hepatis following initial transection. RESULTS:Thirty-five patients were included, of whom 12 (34.3%) underwent ICG-guided surgery. Overall, JF was achieved in 27/35 patients (77.1%), with no significant difference between the non-ICG and ICG groups (19/23, 82.6% vs 8/12, 66.7%; p = 0.40). The 1-year NLS rate was 25/35 (71.4%), without a significant difference between groups (73.9% vs 66.7%; p = 0.70). After adjustment for age at operation, ICG guidance was not significantly associated with JF (adjusted OR 0.47, 95% CI 0.08-2.60; p = 0.385). Among ICG-guided cases, additional cuts based on ICG fluorescence were performed in 6/12 patients (50.0%), without differences in JF (66.7% vs 66.7%; p = 1.00) or 1-year NLS (66.7% vs 66.7%; p = 1.00) between cases with and without additional cuts. CONCLUSIONS:ICG guidance influences intraoperative decision-making during Lap-KPE, as reflected by additional transection, but was not associated with improved short-term outcomes. LEVEL OF EVIDENCE:Level III.
AIM:To develop and validate simulation models for thoracoscopic and percutaneous cryoanalgesia and compare biological with synthetic designs. METHODS:Four cryoanalgesia simulation models (percutaneous and thoracoscopic, biological and synthetic) were developed and evaluated. First, we utilized biological components (porcine or caprine ribs integrated into 3D-printed platforms). After, we employed synthetic models using 3D-printed ribs with ballistic gel or thermosensitive conductive material. The models were used during structured training sessions led by chest wall surgical specialists. PARTICIPANTS:evaluated six domains for percutaneous simulation models and five for thoracoscopic models using a 5-point Likert scale. Demographic data and surgical experience were recorded. Comparisons between biological and synthetic models were performed using Student's t-test. RESULTS:Biological models were used by 24 specialists, 62.5% had over 10 years of surgical experience. Synthetic models were evaluated by 14 specialists, with 57% having over 5 years of experience. All the models achieved high ratings across the eleven evaluated domains, with mean scores being consistently ≥4, and an overall pooled mean score of 4.46/5. There were no statistical differences between biological and synthetic models in any of the assessed characteristics. CONCLUSIONS:All four simulation models provided realistic and effective training platforms for thoracoscopic and percutaneous cryoanalgesia. Synthetic models demonstrated equivalent performance to biological models while offering advantages in durability, portability, and sustainability. These models represent a valuable tool for structured training and may help shorten the learning curve for pediatric thoracic cryoanalgesia.
BACKGROUND: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 METHODS: 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). RESULTS: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 3-9 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. CONCLUSION: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.
PURPOSE:Esophageal leaks in children are associated with significant morbidity. While they are traditionally managed with prolonged fasting and drains, endoluminal vacuum-assisted closure (EVAC) is a minimally invasive alternative. We evaluated outcomes and factors associated with EVAC success. METHODS:Retrospective single-center review of pediatric patients treated with EVAC for esophageal leaks (2019-2025). Leak episodes were analyzed independently. Data included leak characteristics, timing of EVAC initiation, procedural details, and outcomes. The primary outcome was leak resolution without surgery. RESULTS:Thirty-eight children with 40 leak events were included. Median age was 1.5 years (IQR 0.6-2.5). Etiologies included postsurgical (53%), endoscopic (45%), and perforation due to foreign body ingestion (2.5%); 78% were contained leaks. EVAC achieved leak resolution without surgery in 83% of cases (94% endoscopic vs 71% surgical). Median time to closure was 11 days (IQR 6-16). Median number of EVAC exchanges was 2 (IQR 1-3). During EVAC therapy, most patients maintained enteral post-pyloric feeding (65%), and drains were only required in 26%. No EVAC-related adverse events occurred. Strictures requiring surgery developed in 31%. CONCLUSION:EVAC is an effective treatment strategy for pediatric esophageal leaks, with high rates of leak resolution without surgery. Many patients were managed without pleural drainage while maintaining enteral nutrition, supporting EVAC as an active treatment option for selected pediatric esophageal leaks.
AIM:To evaluate the safety and fluorescence performance of an ultra-low-dose, short-interval indocyanine green (ICG) protocol in pediatric fluorescence guided surgery (FGS), and to compare dose and timing with pediatric publications. METHODS:A multicenter retrospective analysis of prospectively collected data from pediatric patients undergoing FGS with ICG at eight institutions between March 2021 and November 2025. Variables included demographics, target structures, ICG dosing, and timing, which were compared to established pediatric dosing guidelines: 0.25-0.5 mg/kg given 45-720 minutes prior to biliary imaging, and a bolus of 0.1-0.5 mg/kg for angiography and tissue perfusion. RESULTS:In 28 cases, more than 89% of intraoperative visualizations were rated satisfactory. The median ICG dose for biliary imaging was 0.05 mg/kg (0.03-0.11), corresponding to a 60-90% reduction compared with published recommendations. Administration occurred 30-75 min before visualization (median 55 min), which is below the intervals reported in the pediatric literature (45-720 min). Biliary procedures achieved reliable delineation of the common bile duct and cystic structures, showing favorable visualization at lower levels than previously reported. Perfusion applications also produced effective fluorescence using 0.05 mg/kg. CONCLUSIONS:This multicenter study demonstrated that very low doses of ICG administered at short intervals are safe and can be reliable for FGS in children. Clear imaging was achieved despite the use of lower doses and shorter timing than current guidelines recommend. These findings support the adoption of the lowest effective ICG dose in pediatric FGS.
OBJECTIVE:To compare the mid-term outcomes of robot-assisted Kasai portoenterostomy (RAKPE) and open Kasai portoenterostomy (OKPE) in children with biliary atresia. METHODS:In this retrospective dual-center cohort study, 70 children with biliary atresia underwent Kasai portoenterostomy between January 2022 and February 2024, including 38 who underwent RAKPE and 32 who underwent OKPE. Overall postoperative complications, jaundice clearance rate (JCR), cumulative incidence of cholangitis, liver stiffness, and native liver survival (NLS) were compared. Follow-up continued through February 2026. RESULTS:The overall complication rate was lower in the RAKPE group than in the OKPE group (10.5% vs. 31.2%, P = 0.038). JCR was higher after RAKPE, although the difference was not statistically significant (73.7% vs. 53.1%, P = 0.074). The cumulative incidence of cholangitis was comparable between groups at 6 months (17.9% vs. 18.3%, P = 0.920), but was lower in the RAKPE group at 1 year (22.6% vs. 33.7%, P = 0.031) and 2 years (31.2% vs. 43.3%, P = 0.022); however, the overall between-group difference was not statistically significant by Gray's test (P = 0.174). Liver stiffness did not differ significantly between groups. NLS was better in the RAKPE group (log-rank χ2 = 5.44, P = 0.020); the 1- and 2-year NLS rates were 78.9% and 68.4% versus 75.0% and 53.1%, respectively. CONCLUSIONS:Compared with OKPE, RAKPE was associated with fewer postoperative complications, a lower mid-term cumulative incidence of cholangitis, and improved native liver survival in children with biliary atresia.
INTRODUCTION:To compare postoperative complications among three common gastropexy techniques used in pediatric patients undergoing laparoscopic gastrostomy tube (GT) placement. METHODS:Patients ≤ 7 years of age who underwent laparoscopic GT placement at our institution between 1/2019-1/2025 were retrospectively reviewed. Patients were categorized and compared based on gastropexy technique: external transabdominal, buried transabdominal, or laparoscopic-assisted trans-fascial. The primary outcome was 30-day surgical site infection. Secondary outcomes included other postoperative complications, such as tube dislodgement, granulation tissue, reoperations, and mortality. RESULTS:A total of 916 patients were analyzed: 86 (9.4%) external transabdominal sutures, 254 (27.7%) buried transabdominal, and 576 (62.9%) laparoscopic-assisted trans-fascial. Median age was 11 months [IQR 5.0, 24.0] and weight was 8.01 kg [IQR 5.53, 11.20]. There was no statistically significant difference in demographics across the three groups. There were no statistically significant differences among the external transabdominal, buried transabdominal and laparoscopic-assisted trans-fascial cohorts in 30-day surgical site infections (2.3% vs. 3.1% vs. 4.9%, p=0.455), emergency department visits (11.6% vs. 12.2% vs. 13.5%, p=0.805), or hospital readmissions (2.3% vs. 2.0% vs. 4.5%, p=0.189). Similarly, there was no difference in 90-day outcomes among the cohorts: GT dislodgement (12.8% vs. 7.1% vs. 6.6%, p=0.119) and GT site granulation tissue (60.5% vs. 54.3% vs. 57.1%, p=0.572). On regression analysis, there were no factors associated with an increased risk for SSI. CONCLUSION:Postoperative complications did not differ across three gastropexy techniques. Granulation tissue formation was the most frequent complication, whereas SSI occurred less commonly and was not independently associated with gastropexy technique or suture type. Gastropexy method may be selected based on surgeon preference without increasing the risk of adverse postoperative outcomes following laparoscopic gastrostomy tube placement.
INTRODUCTION:To determine if the intraoperative timing of intercostal nerve cryoablation (INC) during minimally invasive repair of pectus excavatum (MIRPE) impacts postoperative opioid use or outcomes. METHODS:A single-center, retrospective cohort study of patients aged ≤21 years who underwent MIRPE with INC from 2023 to 2025 was evaluated. Patients were stratified by timing of INC during their MIRPE operation: INC before bar placement versus INC after bar placement. Patient demographics, operative details, opioid use, and postoperative outcomes were collected. RESULTS:A total of 151 patients who underwent MIRPE with INC were analyzed. Of these, 41 (27%) underwent INC before bar placement while 110(73%) underwent INC after bar PLACEMENT: The two groups were similar in age, weight, gender, BMI, and pectus severity. There was no statistically significant difference in inpatient opioid use (in oral morphine equivalents (OME)) (0.20 vs 0.19 OME/kg/day, p=0.751) or discharge opioid use (1.02 vs 1.19 OME/kg, p=0.148). On multivariable analysis adjusting for regional nerve block use, number of bars, and intercostal levels treated, neither cryoablation timing nor regional nerve block use was independently associated with inpatient opioid consumption (p = 0.577 and p = 0.775, respectively). Hospital length of stay, emergency department visits within 30 days, and 30-day readmissions were comparable between the two cohorts. CONCLUSION:INC was most often performed after bar placement during MIRPE in this cohort. The timing of intercostal nerve cryoablation relative to bar placement does not significantly impact opioid use or postoperative outcomes, suggesting timing of INC can be left up to surgeon discretion.
BACKGROUND:The incidence and patterns of cervical spine injury (CSI) have not been well described in children who present after suspected child physical abuse (CPA). The purpose of this study was to describe the pattern of CSI in patients evaluated for suspected CPA in a large, prospectively collected dataset. METHODS:This is a secondary analysis of a prospectively collected, multicenter, pediatric CSI dataset which included 72 trauma centers across the United States. All children with suspected CPA were included, with concerns for CPA determined by each participating center. All children had cervical spine imaging within 24 hours of injury. RESULTS:Among 19,995 pediatric blunt trauma patients, 1,251 children with suspected CPA were identified. Median age was 6 months (IQR 2-12), 42% female, 19% presented with a GCS less than 14, and 11% required intubation. Concomitant traumatic brain injury (TBI) was present in 61% of patients. Overall, 75 children (6%) were diagnosed with CSI. Ligamentous injury was most common (68%), followed by spinal cord injury (19%). No patient underwent operative cervical spine stabilization. Unstable ligamentous injury occurred in seven patients. Four were identified on CT, three were detected on MRI. One patient had a normal initial XR prior to MRI diagnosis with a presenting GCS of 10. On multivariable regression, GCS 3-13 (OR 3.29, 95% CI 1.61-6.47), and intubation (OR 3.07, 95% CI 1.57-6.27) were associated with CSI. CONCLUSION:In this large prospective multicenter cohort, CSI occurred in 6% of children evaluated for suspected CPA and consisted primarily of ligamentous injuries. Low GCS and intubation were strongly associated with CSI. Unstable injuries were rare, CT identified all injuries in which it was performed, and no missed unstable injuries were observed in neurologically intact children with normal screening radiographs. These findings suggest that CT may be a useful adjunct for CSI evaluation in obtunded patients with suspected CPA (GCS < 14) and support a low threshold for advanced imaging in this population. In children with suspected physical abuse who undergo CT imaging, our findings support that a normal CT may be sufficient to allow removal of cervical immobilization regardless of mental status.
INTRODUCTION:The optimal timing of inguinal hernia repair (IHR) in premature infants remains unclear. Our study aims to compare recurrence rates between IHRs performed before and at/after 55 weeks postmenstrual age (PMA). METHODS:A multicenter retrospective cohort study was conducted of premature infants who underwent IHR at ≤1 year of age between 1/2017-12/2019. The primary outcome was inguinal hernia recurrence, defined as recurrence requiring surgical re-repair. Demographic, clinical, perioperative and postoperative variables were analyzed. Multivariable logistic regression was performed to identify factors associated with recurrence. RESULTS:A total of 2,412 premature infants underwent 3,808 IHRs: 3,292 (86.4%) hernias were repaired early (before 55 weeks PMA), and 516 (13.6%) were repaired late (after 55 weeks PMA). Incarceration rates were similar between the groups (9.4% vs. 8.2%, p=0.422), as were the proportion of repairs performed laparoscopically (30.0% vs. 31.2%, p=0.594). Patients undergoing early repair were more frequently admitted postoperatively (81.2% vs. 27.2%, p<0.001). There were no significant differences in hernia recurrence (1.2% vs. 0.8%, p=0.358) or time to recurrence (3 months [IQR 2.0, 9.0] vs. 9 months [IQR 4.3, 11.5], p=0.218) between early and late repair groups. On multivariable regression, laparoscopic repair (OR 1.910 [95% CI 1.018, 3.581], p=0.044) and concurrent procedure (OR 2.046 [95% CI 1.034, 4.047], p=0.040) were independently associated with a higher risk of recurrence, while late repair was not (OR 0.749 [95% CI 0.259, 2.165], p=0.593). CONCLUSION:Time of repair was not an independent predictor of hernia recurrence. Therefore, recurrence risk alone should not drive the decision for early repair; rather timing should be individualized based on patient physiology, anesthetic considerations, and reliability of follow-up.
BACKGROUND:Guidelines endorse metabolic and bariatric surgery (MBS) for eligible adolescents with severe obesity. We described trends in MBS among eligible adolescents and characterized demographic and clinical features, postoperative healthcare utilization, and complications. METHODS:Using Epic Cosmos, we conducted a retrospective, population-based study of US adolescents aged 12-19 years from 2016 through 2025. The primary outcome, annual MBS utilization among eligible adolescents, was modeled by negative binomial regression. Secondary outcomes (patient characteristics, healthcare utilization, complications) were assessed with t-tests, chi-square, weighted least-squares, and logistic regression. RESULTS:Overall, 5,430 adolescents underwent MBS, with utilization rising 7.7-fold from 31 to 239 per 100,000 eligible (p<0.001); at peak, only 0.24% of those eligible underwent MBS. Sleeve gastrectomy (SG) predominated (89.1%). Utilization was steeply graded by obesity severity: by 2025, adolescents with a BMI ≥50 kg/m2 underwent SG roughly nine times as often as those at the lowest eligible BMI class (605 vs 69 per 100,000). Mean length of stay declined from 2.0 to 1.6 days (p<0.001). Serious early complications were uncommon: within 30 days, surgical and infectious complications each affected ≤0.6% of patients, and cardiovascular and thromboembolic events ≤0.3%. The most common diagnoses were gastrointestinal and biliary: nausea and vomiting (12.5%) by one year and cholecystectomy (7.5%) by three years. Reoperation, conversion to gastric bypass, and death were rare (each <0.4%). CONCLUSIONS:Despite increasing use, only a small fraction of eligible adolescents undergo MBS. Given low complication rates, these data highlight a need to expand more equitable access and implementation within clinical workflows.
BACKGROUND:Surgical reconstruction has traditionally been considered the standard of care for imperforate anus with recto-perineal fistula. However, increasing recognition of the role of functional anatomy raises the possibility that selected patients may be managed without surgery. METHODS:We conducted a single-center retrospective cohort study of children with imperforate anus and perineal fistula managed either non-operatively or surgically. Patients were selected for non-operative management based on clinical assessment of fistula caliber, perineal body, and sphincter muscle coverage. Long-term bowel function was evaluated using a standardized ARM-Net-based questionnaire derived from the Rintala score. Clinical outcomes and need for delayed surgical intervention were recorded. RESULTS:A total of 97 patients with recto-perineal fistula were included, of whom 62 (63.9%) were managed non-operatively. At a mean follow-up age of 7.0 ± 3.0 years, most non-operatively managed patients achieved normal bowel function (73.3%), with low rates of constipation and minimal need for bowel management. No patients required delayed surgical reconstruction. Compared to a contemporaneous surgical cohort (n = 35), non-operatively managed patients demonstrated superior functional outcomes; however, these findings reflected baseline differences in anatomical characteristics, including greater sphincter muscle coverage. On univariable analysis, favorable anatomical features and non-operative management were associated with normal bowel function. CONCLUSIONS:In carefully selected patients with imperforate anus and recto-perineal fistula, non-operative management is associated with excellent long-term bowel function and may obviate the need for surgical reconstruction. These findings support a more individualized, anatomy-based approach to management.
Aim To identify and describe health literacy (HL) profiles and possible associations with sociodemographic and clinical characteristics among parents of children with congenital colorectal conditions. Methods Parents (n=269) of children with Hirschsprung disease (HD) or anorectal malformation (ARM) completed the Health Literacy Questionnaire-parent version (HLQ-p) and the General Self-Efficacy Scale. Demographic and clinical data were collected. Ward’s hierarchical clustering was used to identify clusters across the nine HLQ-p domains. Ethical approval was obtained. Results Four parental HL profiles were identified. Cluster 1 (n=75, 28%) showed consistently low HL across all domains, with particular difficulties in information appraisal and social support. This cluster had the lowest self-efficacy, lower educational attainment, nearly half were non-native speakers, and half were not living with the child’s other parent. Cluster 2 (n=57, 21%) demonstrated moderate HL, but distinct challenges in information appraisal. Many had high education, cohabitated, and were native-speaking households. This group had the highest prevalence of child comorbidity. Cluster 3 (n=109, 41%) exhibited generally high HL and strong engagement with healthcare providers, but struggled with information appraisal. Self-efficacy was high, and most parents lived with the child’s other parent. Cluster 4 (n=28, 10%) had the highest HL and self-efficacy, a high proportion of parents with high education and universal cohabitation. Conclusion Nearly half of the parents exhibit low HL, including many with traditionally advantageous sociodemographic characteristics. Language diversity and child comorbidity amplified HL challenges, and difficulties in evaluating and applying health information were common across all parent groups.
BACKGROUND:Congenital lung malformations (CLMs) are often diagnosed prenatally, with high-risk cases potentially benefiting from perinatal intervention. We report outcomes following perinatal intervention for CLMs across a national multicenter cohort. METHODS:Retrospective analysis of prenatally diagnosed CLMs (2016-2024) from a 17-center consortium was performed. Prenatal characteristics, procedural details, and outcomes were analyzed for patients undergoing ex utero intrapartum treatment (EXIT), cesarean section-to-immediate resection (STR), or emergent resection within 24 hours of birth (ER). RESULTS:Of 1756 CLM patients, 25 (1.4%) underwent perinatal intervention: 15 EXIT (0.9%), 4 STR (0.2%), and 6 ER (0.3%). Among EXIT cases, 11 (73%) underwent EXIT-to-resection and 4 (27%) EXIT-to-airway. Most lesions were large, with a median congenital pulmonary airway malformation volume ratio (CVR) at delivery of 2.3 (IQR 1.57-2.70). Mediastinal shift was universal (100%), while hydrops was present in 33%. Congenital pulmonary airway malformation (CPAM) was the most common pathology-based diagnosis among EXIT patients (87%). Procedural survival was 15/15 (100%) for EXIT, 4/4 (100%) for STR, and 5/6 (83%) for ER. Thirty-day survival was 13/15 (87%) for EXIT, 4/4 for STR, and 3/6 for ER. ECMO was used in 2/15 EXIT, 1/4 STR, and 1/6 ER neonates. Median NICU length of stay for survivors was 30 days (EXIT), 24 days (STR), and 25 days (ER). CONCLUSION:Perinatal intervention for CLM remains rare. These findings provide contemporary multicenter data on EXIT, STR, and ER and may help inform prenatal counseling and delivery planning. Further study is warranted to refine patient selection for perinatal intervention and delivery modification.
BACKGROUND:Acute appendicitis in leukopenic pediatric cancer patients is a clinical challenge. While the perceived risks of surgery in this population may delay immediate appendectomy, we sought to identify the consequences of delaying surgery based on the severity of leukopenia at diagnosis. We hypothesized that leukopenic cancer patients are more likely to experience delayed appendectomy and that delay would be associated with worsened outcomes. METHODS:Using ACS NSQIP-P data from 2016-2023, we identified pediatric oncology patients who underwent appendectomy for acute appendicitis. Leukopenic patients (< 4,000 WBC/μL) were stratified by preoperative WBC count as: < 1,000, 1,000-<2,500, and 2,500-<4,000 WBC/μL. Delayed appendectomy was defined as surgery 24 hours or more from admission. The primary outcome was the prevalence of complicated appendicitis. Bivariate comparisons were made using chi-square and nonparametric tests, with p<0.05 considered significant. RESULTS:Of 310 pediatric cancer patients, 84 (27.1%) experienced delayed appendectomy. Median time to operation was significantly longer for leukopenic patients (22.7 hours vs. 11.8 hours, p<0.001). Patients with leukopenia with delayed appendectomy were more likely to have complicated appendicitis (29.2% vs. 2.0%, p<0.001); this association was not observed in non-leukopenic patients. Within each stratum of leukopenic patients, delayed appendectomy was associated with significantly longer length of stay. CONCLUSION:Leukopenic pediatric oncology patients experienced longer delays to appendectomy for acute appendicitis than non-leukopenic patients. Among leukopenic patients, delaying appendectomy by over 24 hours was associated with an increased proportion of complicated appendicitis and prolonged hospitalization, supporting early operative management regardless of leukopenia severity.
PURPOSE:Survivorship, optimization of physical, mental, and emotional health, and quality of life after injury, is critical. We developed the first ever Pediatric Trauma Quality of Life (pTQOL) Clinic, focused on pediatric firearm injury. Our goal was to review the first-year experience of this clinic. METHODS:Patient demographic and injury characteristics were captured for the first year of the clinic from the institutional trauma registry. Additional data were obtained from chart review about index hospitalizations and clinic visits. Reflections on pTQOL experiences were elicited from team members, patients, and families. RESULTS:A total of 126 pTQOL encounters were scheduled for 86 patients. Among those, 57 were completed by 49 patients. The median age at injury was 16.39 years, ranging from 3.07 to 17.98 years. Most patients were male firearm injured youth. Services seen during clinic visits included General Surgery, Psychology, Physical Therapy, Social Work, Hospital-Based Violence Intervention Programs, and Orthopedic Surgery. pTQOL visits led to 56 new referrals for 29 patients in a variety of specialties with bullet excisions scheduled for 4 patients. pTQOL team members, patients, and families reported high levels of satisfaction with the clinic. CONCLUSION:The first ever pTQOL Clinic was successful in its first year. pTQOL provided an opportunity for patients to engage with multiple services in one appointment, including Social Work and Psychology, which are often limited in the post discharge setting, and led to numerous new referrals. Additional process improvements are underway in response to variable appointment completion rates and identified challenges.
PURPOSE:This study characterizes the geographic distribution of pediatric surgical practices in the U.S. relative to the pediatric population (ages 0-17 years). Prior analyses estimated that over 10 million children (14.8%) live more than 60 miles from a pediatric surgeon, overlooking outreach clinics that extend access and reduce travel distances. Our goal was to generate a more accurate assessment of travel burden using data that includes all practice locations. METHODS:The APSA membership directory was used to identify pediatric surgery practices. Practices were contacted for information on faculty and the number and location of hospitals and clinics as of July 31, 2025. Practice locations were compared to population demographics from the US 2020 Census data calculating straight-line driving distances both across and within state lines. RESULTS:A total of 248 unique primary hospital and clinic sites were identified. An additional 684 hospital locations and 512 clinic locations were also identified. The average travel distance to the practice's primary location (hospital or clinic) for children traveling across state lines (ASL) was 55.0 miles, and within states travel (WSL) was 63.4 miles, with 13.2% of children living >60 miles from care (n = 9,662,011). Including all 932 hospitals served by these practices, average distances decreased slightly to 50.3 miles ASL and 58.2 miles WSL, with 11.1% >60 miles (n = 8,125,546). For the 248 primary clinics; distances to care were similar to those from the primary hospitals. Considering all clinics (n = 760), distances decreased to 41.5 miles ASL and 48.1 miles WSL, with only 6.7% of children >60 miles away (n = 4,928,417). CONCLUSIONS:Pediatric surgical care is unevenly distributed in the United States. Both outreach hospitals and clinics can positively impact travel distances for patients. This impact is even greater when children are allowed to cross state lines for pediatric surgical care. These findings support workforce planning and resource allocation to ensure pediatric surgeons are available where children need them most.
