Sleeve gastrectomy (SG) has become the predominant metabolic and bariatric surgery procedure in adolescents in the United States, whereas Roux-en-Y gastric bypass (RYGB) is performed less often. Although both operations are established treatment options, contemporary data clarifying how adolescents are selected for RYGB versus SG remain limited. In particular, it is unclear whether procedure choice is associated primarily with BMI, obesity-related disease burden, or demographic factors. We compared preoperative characteristics of adolescents undergoing RYGB versus SG and identified factors independently associated with RYGB. We analyzed the 2021–2023 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database, restricting to adolescents aged 13–18 years undergoing SG or RYGB. Demographics, BMI, obesity-related conditions, laboratory values, and procedure status were compared. Multivariable logistic regression estimated adjusted odds of RYGB. Among 2,465 adolescents, 2,281 (92.6

Pediatric obesity affects nearly 1 in 5 U.S. youth, with greater burden among low-income and minority populations. Although bariatric surgery is effective treatment for severe obesity, equitable access to multi-disciplinary care remains a concern for many children and adolescents. This study examined whether ZIP code-level poverty and broader social vulnerability are associated with age at surgery, and whether gender or insurance type modifies this relationship. We reviewed charts of patients under 21 who underwent sleeve gastrectomy at three pediatric hospitals (2013–2024). Demographic and clinical data were collected. ZIP code poverty rates were assigned using ACS 5-Year Estimates, and social vulnerability was assessed using the Social Vulnerability Index (SVI). Multiple linear regression assessed associations with age at surgery, adjusting for year of surgery and center and including interactions by gender and insurance type. Among 318 patients (38

BACKGROUND:Adult studies suggest surgeon gender influences postoperative outcomes. The objective of this study was to assess whether surgeon gender and surgeon-patient gender concordance affect postoperative outcomes and resource use in pediatric appendectomy. METHODS:This was a retrospective cohort study of children undergoing appendectomy (7/2015-6/2020) using NSQIP-Pediatric data from 13 hospitals participating in a regional research consortium. Primary exposure was surgeon gender. Outcomes included 30-day surgical site infection (SSI), reoperation, percutaneous drainage, hospital revisits, postoperative imaging, operative duration, and length of stay. Mixed-effects multivariable regression models adjusted for patient, surgeon and hospital-level factors. RESULTS:The cohort included 7695 children. Female surgeons comprised 26.3% (31/118) of surgeons, performed 30.1% (2317/7695) of appendectomies, and had fewer mean years in practice than male surgeons (8.9 vs 13.4 years; P < 0.001). Surgeon gender was not associated with SSI (3.8% [88/2317] vs 3.9% [212/5378]; adjusted odds ratio [aOR] 1.13; 95% CI, 0.85-1.51), reoperation (1.1% [26/2317] vs 1.2% [65/5378]; aOR, 1.09; 95% CI, 0.67-1.77), or percutaneous drainage (3.0% [70/2317] vs 3.7% [197/5378]; aOR, 1.30; 95% CI, 0.95-1.79). No associations were observed for hospital revisits (aOR, 1.07; 95% CI, 0.88-1.30), postoperative imaging (aOR, 0.98; 95% CI, 0.79-1.21), operative duration (adjusted mean ratio [aMR], 1.00; 95% CI, 0.96-1.04), or length of stay (aMR, 1.04; 95% CI, 0.96-1.13). Findings were consistent in subgroup analyses of complicated appendicitis and surgeon-patient gender concordance. CONCLUSIONS:Surgeon gender and surgeon-patient gender concordance is not associated with postoperative outcomes or resource utilization in pediatric appendectomy.

Metabolic and bariatric surgery (MBS) is the most effective and reliable treatment for weight loss and resolution of associated medical problems. However, postoperative weight loss outcomes vary, and psychological factors may contribute to these differences. In our practice, clinical psychologists assess patients’ perceptions of major contributors to their weight gain prior to surgery, but limited research has examined how these perceptions relate to postoperative outcomes. Understanding this relationship may inform perioperative counseling and support individualized care plans. This retrospective study included patients who underwent MBS at a single institution in 2019 and 2020. Patient responses describing perceived contributors to weight gain were coded using a combined inductive-deductive approach. Chi-square tests examined associations between perceived contributor categories. Univariate and multivariable regression models assessed the relationship between perceived contributors and percent total body weight loss (

Sleeve gastrectomy (SG) is widely recognized for its association with gastroesophageal reflux disease (GERD) and reduced sustained weight loss in the long term. The Single Anastomosis Sleeve Ileal (SASI) bypass was introduced as an alternative to enhance the metabolic benefits of SG, improve GERD outcomes, address nutritional challenges of ileal bypasses, and maintain duodenal access. This study is a systematic review and meta-analysis of the comparative safety and efficacy of SASI bypass vs SG. A literature search in PubMed, Scopus, Embase, and Cochrane identified 234 articles after duplicate removal. Primary outcomes were GERD remission and complication rates over the follow-up period of each study including all complications reported by the authors, while secondary outcomes included weight loss and obesity-related condition remission. Thirteen studies, including 2 RCTs and eleven observational studies, analyzed 960 SG and 396 SASI bypass patients. SASI bypass showed significantly higher GERD remission (OR 7.64; 95

Childhood obesity is increasingly prevalent and historically considered a risk factor for surgical complications. Evaluating the influence of body mass index (BMI) on pediatric surgical outcomes is critical for guiding care. This study aimed to examine the relationship between BMI and postoperative outcomes in children. Cohort study of patients aged 2–18 years undergoing general surgical, urological, or gynecological procedures at National Surgical Quality Improvement Program-Pediatric hospitals (2012–2023). The exposure was BMI categories defined by American Academy of Pediatrics and Centers for Disease Control and Prevention. The primary outcome was the Desirability of Outcome Ranking (DOOR), a composite measure of 22 postoperative events ranked from 1 (no complication) to 6 (worst complications). Ordinal logistic regression models, adjusted for clinical risk, assessed the association between BMI and DOOR. Among 373,315 patients (mean age 10.8 ± 4.7 years; 54.2

INTRODUCTION:Minimally invasive repair of pectus excavatum (MIRPE) is associated with significant postoperative pain, and opioid use remains common despite Enhanced Recovery After Surgery (ERAS) protocols. Cryoanalgesia has emerged as a promising adjunct to improve pain control, but its comparative effectiveness within established ERAS pathways remains incompletely defined. We aimed to evaluate opioid use and recovery outcomes following cryoneurolysis compared to a thoracic epidural-based ERAS protocol. METHODS:We performed a retrospective cohort study of pediatric and young adult patients undergoing MIRPE from 2017 to 2024. Outcomes included inpatient opioid use and outpatient opioid prescribing (MME/kg), length of stay (LOS), and postoperative care utilization. Groups were compared using appropriate univariate tests, and multivariable models adjusted for age, Haller index, and calendar year of surgery. RESULTS:Among 245 patients (median age 16.0 years), 124 (50.6%) received cryoanalgesia. Baseline characteristics were similar between groups. Cryoanalgesia was associated with significantly reduced opioid use and prescribing (inpatient: 6.10 vs. 18.55 MME/kg; outpatient: 1.70 vs. 7.91 MME/kg; both P < 0.0001) and shorter LOS (2.01 vs. 3.25 days, P < 0.0001), with these associations remaining significant after adjustment for age, Haller index, and calendar year of surgery. Routine outpatient care needs and surgical complication rates were similar between groups. Cryoanalgesia was associated with a modest increase in unplanned postoperative visits, without a difference in the proportion of patients affected (28.1% without cryoanalgesia vs 22.6% with cryoanalgesia, P = 0.322). CONCLUSION:Cryoneurolysis was associated with substantial reductions in opioid use and shorter hospitalization without increased routine follow-up. A modest increase in unplanned visits warrants further study. These findings support cryoanalgesia as an effective adjunct to multimodal pain management in MIRPE. IRB APPROVAL STATEMENT:This protocol was approved by the Institutional Review Board at Mass General Brigham, and a waiver of informed consent for medical records review was obtained (Protocol #: 2025P001162).

INTRODUCTION:The Desirability of Outcome Ranking (DOOR) ranks multiple postoperative outcomes, potentially enhancing detection of risks influenced by social determinants of health. We examined the relationship between race, ethnicity, and DOOR scores in pediatric surgical patients. METHODS:Using NSQIP-Pediatric 2012-2022, we identified patients (≤18 years) who underwent general, urological, and gynecological surgery. DOOR scores range from 1 (most desirable) to 6 (least desirable). Ordinal logistic regression assessed associations with race, ethnicity and DOOR scores. RESULTS:Among 368,190 patients (64.3 ​% non-Hispanic White, 18.2 ​% Hispanic, 13.4 ​% non-Hispanic Black, 3.7 ​% non-Hispanic Asian, and 0.4 ​% non-Hispanic Native), Black patients had increased odds of higher DOOR scores (OR 1.06, 95 ​% CI 1.04-1.10), while Hispanic patients had decreased odds of high DOOR scores (OR 0.89, 95 ​% CI 0.86-0.92). In general and non-elective surgery, Black race was still significantly associated with higher DOOR scores. CONCLUSIONS:Black children faced greater odds of undesirable outcomes. Future work may inform equitable, targeted interventions.

Introduction Laparoscopic inguinal hernia repair (IHR) is being performed more frequently in children, but few studies have evaluated surgical practice patterns in infants. In this study, we surveyed pediatric surgeons within a regional consortium to assess current preferences for IHR strategy in infants. We hypothesized that early-career pediatric surgeons would prefer laparoscopic IHR over open IHR in this patient population. Methods A Qualtrics survey addressing surgeon preferences for IHR was distributed to 160 pediatric surgeons at 19 member institutions affiliated with the Eastern Pediatric Surgery Network. Surgeons were stratified by self-reported number of years in attending practice. Responses were compared using t-tests and chi-square tests wherever appropriate. Results Ninety-eight surgeons responded to the survey (61% response rate; two incomplete responses were excluded). Forty respondents (41.7%) had 0-10 ys of experience, 26 (27.1%) had 10-20 ys of experience, and 30 (31.2%) had over 20 ys of experience. Over 90% of early-career surgeons reported a preference for laparoscopic IHR in infants, compared to less than 50% of mid-career surgeons and less than 20% of late-career surgeons (P < 0.001). Respondents preferring laparoscopic IHR most commonly cited inherent assessment of the contralateral side, confirmation of hernia before repair, and technical ease of the laparoscopic approach as factors contributing to their preference. Conclusions The majority of early-career pediatric surgeons prefer laparoscopic IHR over open IHR in infants, representing a substantial shift away from what is traditionally regarded as the gold standard open technique. Larger studies are needed to compare long-term outcomes after laparoscopic and open IHR in infants.

The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) online calculator incorporates individual patient data to predict weight loss up to 1 year after MBS, but it was derived from an adult database and has not been validated in younger cohorts. This study evaluates the accuracy of this calculator for adolescent MBS patients and explores patient factors which may be associated with prediction inaccuracy. We include patients age ≤ 21 who underwent laparoscopic sleeve gastrectomy at two major academic institutions from 2013 to 2023. Data were stratified between patients age < 18 and 18–21. The calculator’s predictions were compared to actual weight loss values at 1 year. Relationships between various preoperative variables and the difference between predicted and actual weight loss were assessed using correlation, regression, and t-tests. There were 265 patients, with 176 age < 18. The correlation coefficients for predicted and actual weight loss were 0.48 for patients age < 18 and 0.38 for patients 18–21. On average, the proportion of predicted weight loss actually attained at 1 year was 0.73. There were no statistically significant associations between calculator inaccuracy and patient age, sex, preoperative body mass index, or area deprivation index (all p > 0.05). The MBASQIP calculator predictions show weak to moderate correlation with actual weight loss at 1 year and should be used with caution when counseling pediatric patients considering MBS. This project underscores the importance of building multi-institutional collaborations and databases specific to the pediatric MBS context.

OBJECTIVE: To evaluate the efficacy of Resident Education And Counseling on Household (REACH) Firearm Safety, a novel virtual reality (VR) intervention. METHODS: We conducted a single-center, randomized controlled trial among pediatric residents in a Midwestern academic primary care center comparing REACH Firearm Safety with didactic training (intervention) to didactic training alone (control). In the intervention arm, participants practiced firearm safety counseling with virtual characters and received immediate feedback. All residents completed audio-recorded standardized patient (SP) encounters before and after the training as well as a retrospective pre- post survey. Two reviewers, blinded to the allocation arm, used a standardized assessment tool to generate performance scores. Outcomes of interest included the difference between groups in SP performance scores and self-reported confidence. RESULTS: From March to July 2023, 62% of eligible pediatric residents (n = 47/76) completed the allocated study tasks (intervention 19, control 28). In both groups, SP performance scores and self-reported confidence improved. Compared to the control group, the intervention group demonstrated improvement in sharing information on secure storage devices (P = 0.009) and increased confidence in providing information on secure storage (P = 0.002). CONCLUSIONS: Compared with didactic training alone, a VR intervention using deliberate practice improved residents' skills and confidence related to firearm safety counseling.

BACKGROUND:Several studies have advocated for nonoperative management of uncomplicated acute appendicitis, given its favorable safety profile. However, the paucity of data regarding the long-term failure rates of nonoperative management imposes limitations on shared clinical decision-making with patients and families. METHODS:We conducted a systematic review and meta-analysis comparing operative and nonoperative management of acute uncomplicated appendicitis in children (PROSPERO CRD42021270347). Single- or double-arm studies published in MEDLINE and EMBASE between 2000 and 2024 were included. Our primary outcome was nonoperative management failure rate at 1 year, defined as patients who returned with recurrent appendicitis, need for exploratory surgery for abdominal pain, or elective interval appendectomy. Secondary outcomes were rates of 30-day emergency department visits and 1-year readmissions. RESULTS:Initial search yielded 2,249 articles, of which 48 articles were included. One-year mean failure rate was 22.3% (95% confidence interval, 21.7-23.0%), and beyond 1 year was 54.2% (95% confidence interval, 41.4-67.0%). Patients who underwent nonoperative management were more likely to visit the emergency department within 30 days and be readmitted within 1 year compared with those who underwent surgery. CONCLUSION:Our findings demonstrate a 1-year nonoperative management failure rate of more than 20% and more than 50% beyond 1 year. Patients undergoing nonoperative management returned to the emergency department and required readmission more frequently than patients whose acute uncomplicated appendicitis was treated operatively.