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.

Objectives:Data on the incidence of recurrent adhesive small bowel obstruction (ASBO) following index admission for ASBO in children are limited. We sought to determine if operative management was associated with a lower rate of recurrence compared to nonoperative management (NOM).Methods:We conducted a prospective observational study of children with ASBO admitted to 9 hospitals from October 2020 to December 2022 who underwent a trial of NOM. Children were followed for a year after admission. The primary outcome was readmission for recurrent ASBO. Adjusted comparisons were made between children successfully managed nonoperatively at the index admission and those who underwent surgery.Results:Among 136 children, 87 (63.9%) had successful NOM at the index admission. Within 1 year, 20 patients (14.7%; 17/87 NOM group; 3/49 operative group) had recurrent ASBO. On unadjusted analysis, there was a higher risk of recurrent ASBO in the NOM group (19.5 vs 6.1%, P=0.04). However, after adjusting for age (HR: 0.35, CI: 0.10-1.23), there was no significant difference. Among patients with recurrent ASBO, 7/20 (35%) underwent an urgent or emergent operation at readmission; this rate was similar between initial management groups.Conclusions:Although the rate of recurrent ASBO in children is nearly 15% within 1 year, this rate does not differ based on the initial management strategy. Among children with recurrent ASBO, one-third underwent an urgent or emergent operation at readmission. NOM appears to be as effective in preventing recurrent ASBO as surgery.

Objective: Anastomotic stricture (AS) is the most common complication following repair of type C esophageal atresia with distal tracheoesophageal fistula (EA/TEF). Retrospective studies suggest transanastomotic tube (TT) use may increase AS risk, but are limited by design. We conducted a multicenter randomized trial to evaluate the impact of TT placement on AS. Methods: Infants undergoing type C EA/TEF repair at 10 children’s hospitals were randomized to TT placement or no TT. A total of 142 patients (74 no TT, 68 TT) were enrolled. The primary outcome was AS requiring dilation within 12 months. Secondary outcomes included anastomotic leak, feeding outcomes, and postoperative morbidity. Multivariable analysis adjusted for clinically relevant covariates. Results: Baseline characteristics were similar between groups. No statistically significant difference in stricture rates was observed (47.3% no TT vs. 53.7% TT; P =0.45). Rates of leak, infection, reoperation, and readmission were similar. On multivariable analysis adjusting for weight, thoracoscopic approach, anastomotic tension, leak, and acid suppression, TT use was not independently associated with stricture ( OR =1.18, 95% CI, 0.58-2.45; P =0.64). Moderate-to-severe surgeon-assessed anastomotic tension was the only independent predictor of stricture ( OR =2.45, 95% CI, 1.11-5.40; P =0.026). Conclusion: In this multicenter randomized trial, TT use was not associated with a statistically significant difference in AS risk. Anastomotic tension, as assessed intraoperatively by the surgeon, was the strongest predictor of stricture, underscoring the central role of surgical assessment in outcomes.

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.

OBJECTIVE:Anastomotic stricture (AS) is the most common complication following repair of type C esophageal atresia with distal tracheoesophageal fistula (EA/TEF). Retrospective studies suggest transanastomotic tube (TT) use may increase AS risk, but are limited by design. We conducted a multicenter randomized trial to evaluate the impact of TT placement on AS. METHODS:Infants undergoing type C EA/TEF repair at 10 children's hospitals were randomized to TT placement or no TT. A total of 142 patients (74 no TT, 68 TT) were enrolled. The primary outcome was AS requiring dilation within 12 months. Secondary outcomes included anastomotic leak, feeding outcomes, and postoperative morbidity. Multivariable analysis adjusted for clinically relevant covariates. RESULTS:Baseline characteristics were similar between groups. No statistically significant difference in stricture rates was observed (47.3% no TT vs. 53.7% TT; P =0.45). Rates of leak, infection, reoperation, and readmission were similar. On multivariable analysis adjusting for weight, thoracoscopic approach, anastomotic tension, leak, and acid suppression, TT use was not independently associated with stricture ( OR =1.18, 95% CI, 0.58-2.45; P =0.64). Moderate-to-severe surgeon-assessed anastomotic tension was the only independent predictor of stricture ( OR =2.45, 95% CI, 1.11-5.40; P =0.026). CONCLUSION:In this multicenter randomized trial, TT use was not associated with a statistically significant difference in AS risk. Anastomotic tension, as assessed intraoperatively by the surgeon, was the strongest predictor of stricture, underscoring the central role of surgical assessment in outcomes.

INTRODUCTION:To decrease diversion of unused opioids following the minimally invasive repair of pectus excavatum (MIRPE), we developed an opioid education monitoring and reclamation program. The aim was to evaluate outpatient opioid use and disposal following MIRPE. MATERIALS AND METHODS:A retrospective review was conducted at a single center among patients <19 ys who underwent MIRPE with intercostal nerve cryoablation. Demographic and clinical data, including outpatient opioid prescriptions, were reviewed. Patients or families were educated on the risk of opioids and encouraged to bring unused opioid to the first postoperative visit for disposal. Questionnaires were administered on opioid use and disposal plan. RESULTS:A total of 72 patients participated in the program: 83.3% (60/72) were male, and the mean age was 15.2 ± 1.6 ys old. A median of 10 tablets per patient were prescribed, with a total of 790 five-mg oxycodone tablets prescribed. Prior to the first postoperative visit, 20.8% (15/72) of patients required an opioid refill. Patients reported using a median of 5 [IQR: 1.6 - 10], five-mg oxycodone tablets for a median of 5 [IQR: 2 - 6.7] ds: 92% (65/72) had unused opioids totaling 420 tablets. Of patients with unused opioid, 50.8% (33/65) reported a plan for opioid disposal, 30.8% (20/65) reported a plan to keep unused opioids, and 28.5% (12/65) did not disclose a plan of disposal. CONCLUSIONS:Despite conservative opioid prescribing, 53% of outpatient opioids go unused following MIRPE. After education on opioid risks and providing a convenient means for safe opioid disposal, half of the patients or families intended to dispose of unused opioids.

BACKGROUND:Guidelines for adult gallstone pancreatitis (GP) in adults recommend endoscopic retrograde cholangiopancreatography (ERCP) for ongoing biliary obstruction. Studies in children are limited by small sample sizes. We sought to explore whether factors predictive of choledocholithiasis (CDL) are correlated with ERCP findings of stones in pediatric GP. METHODS:We analyzed a subgroup of GP patients from a retrospective pediatric cohort undergoing cholecystectomy across ten hospitals from 2016 to 2019. Those with incomplete records and cholangitis were excluded. The absence of CDL was defined as ERCP that was either negative or not performed because of the resolution of obstruction. Comparative analyses were made between ERCP and non-ERCP patients. RESULTS:Among 1601 children undergoing cholecystectomy, 125 with GP were identified of which 30 (24 %) underwent preoperative ERCP. ERCP patients had a greater mean bilirubin (4.1 vs. 2.4, p = 0.02), median CBD diameter (9 vs. 5 mm, p <0 .001), and visualized stone on MRCP (36.7 vs. 4.2 %, p < 0.001). However, among patients with hyperbilirubinemia (≥1.8 mg/dL) or a dilated CBD (≥6 mm), 71 % of patients did not have CDL. In contrast, only 40 % of patients with a visualized stone on MRCP had a negative ERCP. ERCP was not associated with prolonged length of stay (LOS) or readmissions. CONCLUSION:In children with GP, hyperbilirubinemia and CBD dilation were not reliable predictors of a positive ERCP, potentially leading to unnecessary radiation and/or anesthesia. MRCP with visualized stone was the best predictor of CDL. Although ERCP did not result in greater LOS or readmissions, the use of MRCP prior to ERCP may reduce unnecessary procedures for children with gallstone pancreatitis.

INTRODUCTION:Surgical site infection (SSI) following pectus bar removal (PBR) is one of the most common complications despite being a clean procedure. The effect of preoperative antibiotic use on SSI rates has not been well-studied. This study aimed to evaluate the association of preoperative antibiotic use on SSIs following PBR. We hypothesized that patients who received preoperative antibiotics would have lower SSI rates. METHODS:A retrospective review was conducted of pediatric patients who underwent PBR from January 2018 to July 2023 at a single center. Patient demographic data, preoperative antibiotic administration, and a 30-d postoperative clinical course were collected. SSI was defined as a documented infection adjacent to the surgical incision requiring antibiotics or operative intervention within 30 ds of surgery. RESULTS:There were 198 patients in the cohort. The majority were male (81%), with a median age of 18. Postpectus bar removal SSI was documented in 2% (4/198) of patients, with any complications occurring in 6% of the cohort. Despite being a clean case, 67% received preoperative antibiotics. There was no statistical difference between SSIs in patients who received preoperative antibiotics versus those who did not (0.8% versus 4.6%, P = 0.10). CONCLUSIONS:Following PBR, close to 5% of patients had a documented SSI when antibiotics were not part of routine preoperative care. While we did not find a significant difference in SSI with antibiotic use, the incidence of SSI is higher than in other clean wound class procedures. Further efforts are needed to identify risk factors of SSI following PBR.

INTRODUCTION:Activity restrictions following the minimally invasive repair of pectus excavatum (MIRPE) are often given with the intention of reducing pectus bar displacement (PBD). We aimed to assess the effect of activity restrictions on PBD following MIPRE. METHODS:A ten-center retrospective review was conducted among patients <21 years undergoing MIRPE between 7/1/2022-10/31/2023. Postoperative activity restrictions were categorized into two groups: no restrictions versus any activity restrictions. PBD was defined as bar migration requiring reoperation within 90 days of MIRPE. We compared the incidence of PBD and postoperative outcomes between cohorts. RESULTS:A total of 532 patients were included (mean age - 15.9 ± 2.0 years, male - 86 %, median Haller index - 4.5 [IQR:3.8-5.8]). Postoperatively, 24 % of patients (127/532) were not given activity restrictions. Patients with activity restriction had a higher proportion of pericostal suture use (78 % vs 43 %, p < 0.001) and subpectoral tunneling (58 % vs 36 %, P < 0.001), and a lower proportion of sternal elevation (63 % vs 80 %, p < 0.001) and cryoanalgesia (88 % vs 100 %, p < 0.001) during MIRPE. Overall, PBD occurred in 1.6 % of patients, with no difference in the incidence of PBD between those patients with and without activity restrictions (1.7 % vs 0.8 %, p = 0.468). Additionally, there were no significant differences in other postoperative complications between these groups. CONCLUSION:Ad libitum physical activity after MIRPE was not associated with an increased risk of pectus bar displacement. Activity restrictions may be unnecessary, and consideration should be given to their elimination to accelerate recovery.

Introduction: The physiologic benefits of the minimally invasive repair of pectus excavatum (MIRPE) on cardiopulmonary function are poorly understood in pediatrics. We sought to examine the effects of MIRPE on exercise response during cardiopulmonary exercise testing (CPET). Methods: A prospective-pilot study was conduct of patients <= 18 years who presented for pectus bar removal. All patients had CPET prior to MIRPE and following bar removal. Paired sample T tests were used to compare pre- and post-MIRPE CPET results. Results: Twenty-five patients completed post-MIRPE CPET (72 % male, median age 18.6 [IQR:17.5-19.8]). The median Haller and correction indices were 4.5 and 29.4 %, respectively. There was significant increase in O2Pulse, (10.3 vs 12.1 mL/beat, p = 0.004), and percent predicted O2Pulse (79.5% vs 84.4 %, p = 0.046) following MIRPE/bar removal. The peak-VO2/kg and did not change significantly following MIRPE/bar removal; however, peak-VO2 (ml/min) increased. Patients with decreased activity levels at time of bar removal compared to pre-MIRPE had decreased peak-VO2/kg and predicted peak-VO2/kg. Conclusion: Following MIRPE, patients experience increased in O2Pulse, which is a surrogate measure of stroke volume response to exercise and may reflect relief of cardiac compression. Cardiopulmonary function is multifactorial and despite improvement in stroke volume, other factors may impact exercise capacity (VO2) following MIRPE. (c) 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, andsimilar technologies.

PURPOSE:Pediatric Surgery Quality Collaborative (PSQC) implemented a colon bundle checklist pilot study in 2023 using the NSQIP-P platform. This study aims to analyze bundle compliance in a multicenter surgical quality initiative and identify checklist item specific compliance rates. METHODS:A 7-item perioperative colon bundle checklist was implemented. Custom variables for the checklist items were created on the NSQIP-P platform. Compliance for pediatric colorectal cases between January 2023-September 2024 was analyzed between implementation and control cases and over time. RESULTS:361 cases were analyzed: 62.3 % were controls and 37.7 % were implementation cases. The cohorts were similar in demographics characteristics. Implementation cases significantly outperformed controls in all colon bundle components except pre-operative antibiotics and intraoperative normothermia. Implementation cases adhered to administering preoperative antibiotics (90 %) the most and intraoperative anastomotic leak testing (62 %) the least. Despite being the least compliant bundle item, implementation cases outperformed control cases (44.7 %) in anastomotic leak testing. Implementation cases' mean bundle compliance score increased significantly over time (4.07 vs 5.14, p = 0.010). From 2023 to 2024, implementation cases significantly improved adherence to preoperative umbilical cleansing, antibiotic administration, and glove change prior to closure. Although not statistically significant, superficial surgical site infection occurred more frequently in control cases compared to implementation cases (5.8 % vs. 3.7 %, p = 0.390). CONCLUSIONS:We present the largest multicenter initiative using the NSQIP-Pediatric platform to assess the utilization of a colon bundle checklist for pediatric colorectal surgeries. Significant compliance improvement, albeit imperfect, over 21 months reflects a realistic adoption rate of a multicenter initiative using NSQIP. LEVEL OF EVIDENCE:III.

BACKGROUND:There is no consensus on the appropriate duration of postoperative antibiotics for complicated appendicitis in children. Commonly used antibiotic endpoints include normalization of white blood cell count (WBC) or completion of a minimum number of prespecified treatment days. We compared clinical outcomes resulting from varying postoperative antibiotic protocols for complicated appendicitis in children. METHODS:National Surgical Quality Improvement Program Pediatric (NSQIP-P) data from nine children's hospitals was used to identify a retrospective cohort of children (<18 years) who underwent laparoscopic appendectomy from 2021 to 2023 with intraoperative findings of complicated appendicitis. Participating hospitals were classified into four groups based on discharge protocol: 1) no discharge antibiotics, 2) oral antibiotics for elevated WBC on the day of discharge, 3) oral antibiotics to complete a minimum number of total antibiotic days, and 4) routine discharge antibiotics regardless of inpatient antibiotic duration. Univariate analysis was completed between groups. RESULTS:We identified 1342 patients with complicated appendicitis who underwent laparoscopic appendectomy. Patients were similar by age and BMI. Median length of stay (5 days) and rate of post-discharge percutaneous drainage (9.4 %) were highest at the center with a standardized minimum duration of discharge antibiotics. There were no statistical differences among treatment groups for surgical site infection (5.7-9.8 %), emergency department visits (9.0-15.6 %), or readmissions within 30 days (2.9-7.6 %). CONCLUSION:The incidence of SSI and readmission following appendectomy did not differ based on the discharge antibiotic protocol, however, the incidence of post-discharge drainage was highest in the center with protocolized discharge antibiotics. These findings highlight an opportunity to minimize unnecessary blood draws and extended postoperative antibiotics. LEVEL OF EVIDENCE:III.

OBJECTIVES:Data on the incidence of recurrent adhesive small bowel obstruction (ASBO) following index admission for ASBO in children are limited. We sought to determine if operative management was associated with a lower rate of recurrence compared to nonoperative management (NOM). METHODS:We conducted a prospective observational study of children with ASBO admitted to 9 hospitals from October 2020 to December 2022 who underwent a trial of NOM. Children were followed for a year after admission. The primary outcome was readmission for recurrent ASBO. Adjusted comparisons were made between children successfully managed nonoperatively at the index admission and those who underwent surgery. RESULTS:Among 136 children, 87 (63.9%) had successful NOM at the index admission. Within 1 year, 20 patients (14.7%; 17/87 NOM group; 3/49 operative group) had recurrent ASBO. On unadjusted analysis, there was a higher risk of recurrent ASBO in the NOM group (19.5 vs 6.1%, P =0.04). However, after adjusting for age (HR: 0.35, CI: 0.10-1.23), there was no significant difference. Among patients with recurrent ASBO, 7/20 (35%) underwent an urgent or emergent operation at readmission; this rate was similar between initial management groups. CONCLUSIONS:Although the rate of recurrent ASBO in children is nearly 15% within 1 year, this rate does not differ based on the initial management strategy. Among children with recurrent ASBO, one-third underwent an urgent or emergent operation at readmission. NOM appears to be as effective in preventing recurrent ASBO as surgery.

PURPOSE:Adult trauma literature indicates hemothorax volume >300 mL requires thoracic drainage. Due to a paucity of pediatric literature, we aim to analyze pediatric traumatic hemothorax management and calculate a volume threshold requiring chest tube placement. METHODS:Pediatric traumatic hemothorax cases from two level 1 trauma centers were analyzed. Management was categorized into successful observation (SO), chest tube placement (CTP), and failure of initial observation (FO). Hemothorax volume was calculated using Mergo's formula: d2xl. d = greatest depth on transverse cuts. l = length on sagittal cuts. Hospital course, postoperative and long-term outcomes were measured up to 1 year. RESULTS:406 traumatic thoracic cases were identified, with 74 hemothoraces analyzed: 32 (43 %) SO, 38 (51 %) CTP, 4 (6 %) initial operation, 10 (12 %) FO. We observed increases in injury severity score (p = 0.020) and thoracic abbreviate injury scale (p < 0.001) in CTP versus SO. Presenting tachypnea was not associated with chest tube placement (p = 0.632). Statistically higher hemothorax volume was found in CTP vs SO (142.7 mL vs 19.5 mL, p < 0.001). Utilizing ROC Curve analysis, >55 mL measured with Mergo's formula predicted chest tube placement (p = 0.001). Chest tube placement was associated with increased mechanical ventilation requirement (p < 0.001), hospital length of stay (LOS) (p < 0.001), and ICU LOS (p < 0.001). No patients developed delayed empyema from retained hemothorax. CONCLUSIONS:This is the largest cohort of pediatric traumatic hemothoraces and first in the literature to calculate volume threshold requiring chest tube placement. Judicious application of hemothorax volume calculation and overall injury score may assist in the decision making of pediatric traumatic hemothorax management. TYPE OF STUDY:Retrospective Observational Cohort Study. LEVEL OF EVIDENCE:Level 3 evidence.

Objective:Our objective was to determine the utility of enteral contrast-based protocols in the diagnosis and management of adhesive small bowel obstruction (ASBO) for children.Background:Enteral contrast-based protocols for adults with ASBO are associated with a decreased need for surgery and shorter hospitalization. Pediatric-specific data are limited.Methods:We conducted a prospective observational study between October 2020 and December 2022 at 9 children's hospitals that are members of the Western Pediatric Surgery Research Consortium. Inclusion criteria were children aged 1 to 20 years diagnosed with ASBO who underwent a trial of nonoperative management at hospital admission. Comparisons were made between those children who received an enteral contrast challenge and those who did not. The primary outcome was the need for surgery.Results:We enrolled 136 children (71% male; median age: 12 years); 84 (62%) received an enteral contrast challenge. There was no difference in the rate of operative intervention between the no-contrast (34.6%) and contrast groups (36.9%; P=0.93). Eighty-seven (64%) were successfully managed nonoperatively with no difference in median length of stay (P=0.10) or rate of unplanned readmission (P=0.14). Among the 49 children who required an operation, there was no significant difference in the time from admission to surgery or rate of small bowel resection based on prior contrast administration.Conclusions:The addition of enteral contrast-based protocols for the management of pediatric ASBO does not decrease the likelihood of surgery or shorten hospitalization. Larger randomized studies may be needed to further define the role of radiologic contrast in the management of ASBO in children.

PURPOSE:Gabapentin is used for treating postoperative pain and preventing neuropathic pain. We aimed to examine the effects of gabapentin on opioid use and neuropathic pain following minimally invasive repair of pectus excavatum with intercostal nerve cryoablation (MIRPE-INC). METHODS:A prospective comparison study was conducted among patients ≤21 years old undergoing MIRPE-ICN. Patients were grouped based on perioperative gabapentin use (gabapentin beginning 2 weeks prior to MIRPE-INC from March 2021 to December 2022 and no-gabapentin cohorts from June 2023 to June 2024). Participants underwent chest wall sensory examination and neuropathic pain screening (S-LANSS) pre-MIRPE and post-MIRPE (postoperative day 1 (POD1), 2 weeks, 2 months). S-LANSS score ≥12 was suggestive of neuropathic pain. Additionally, inpatient opioid use, inpatient pain scores, and length of stay (LOS) were recorded. Outcomes were compared between cohorts. RESULTS:Of the 112 patients enrolled, 39 received perioperative gabapentin and 73 did not. Age, Haller index, correction index, and BMI were similar between cohorts. The gabapentin cohort was less likely to have neuropathic pain symptoms (S-LANNS ≥12) on POD1 (11.4 % vs 31.9 %, p = 0.023). At 2 weeks and 2 months postoperatively, the frequency of s-LANSS scores ≥12 was similar between treatment groups, as was the incidence of hyperesthesia on chest wall sensory examination. Total inpatient oral morphine equivalents were similar between cohorts. CONCLUSIONS:Perioperative gabapentin use was associated with a decreased incidence of neuropathic pain symptoms immediately post-MIRPE-INC but did not decrease perioperative opioid use or LOS. Gabapentin did not decrease neuropathic pain symptoms outside the immediate perioperative period. LEVEL OF EVIDENCE:Level 2.

Background: Evaluation of response to blood transfusion after blunt splenic injury (BSI) may prevent the need for splenectomy. The aim of this study was to evaluate factors associated with splenectomy in pediatric patients with isolated BSI who presented with hemodynamic instability with a focus on timing of transfusion. Methods: The 2021 Trauma Quality Improvement Project database was queried for children <= 18 years with BSI who arrived with a shock index>1.1. Interfacility transfer patients and those with additional intra-abdominal injuries were excluded. Demographic, injury characteristic and timing, transfusion, operative, and outcome data were collected. A sub-analysis of patients without brain injury was also performed. Results: 516 patients met inclusion criteria; 60.1% were male, with mean age 12.3 +/- 5.5 years. Initial mean shock index was 1.4 +/- 0.4, ISS was 31.7 +/- 15.1, and GCS was 10.7 +/- 5. Splenectomy occurred in 27% of patients. Among splenectomy patients, 26.2% did not receive blood prior to splenectomy. While treatment at a pediatric trauma center showed an increased OR of splenectomy in univariable analysis, when controlling for lack of transfusion, no differences in splenectomy persisted. Patient Age (aOR-1.26, p < 0.001), BSI grade (aOR-2.30, P < 0.001), male gender, (aOR-2.2, p = 0.003), being non-white (aOR-2.0) ISS (aOR-1.03, p = 0.003), and GCS (aOR-0.95, p = 0.034) were associated with splenectomy. Conclusion: More than 26% of patients undergoing splenectomy did not receive blood prior to surgery. Differences in risk of splenectomy by center type seen on univariable analysis were not seen when controlling for transfusion. Evaluating response to blood transfusion may be an opportunity to reduce the frequency of splenectomy. (c) 2024 Published by Elsevier Inc.

PURPOSE:This study aimed to investigate effect of surgeon annual case volume on pediatric inguinal hernia recurrence rates. METHODS:Surgeons' individual annual case volumes were calculated from a retrospectively collected data set of pediatric inguinal hernia repairs including 21 hospitals from 2017 to 2019. Quartiles were defined based on surgeons' annual case volumes for each year: Lower Volume = Q1-3 and Higher Volume = Q4. Descriptive statistics and bivariate regression were utilized for analysis. RESULTS:For all repair techniques, there were 207 surgeons accounting for 548 surgeon-years with 8519 operations. For all repairs, Higher Volume was defined as > 22 operations per year. On regression analysis, presence of a ventriculoperitoneal shunt, peritoneal dialysis, laparoscopic technique, and surgery performed by a lower volume surgeon were associated with recurrence risk. For open repairs, there were 193 surgeons, 465 surgeon-years, and 5726 operations. Higher Volume was defined as >18 operations per year. On regression analysis, history of an omphalocele, a connective tissue disorder, and tracheostomy dependence contributed to recurrence risk, while surgeon volume did not. For laparoscopic repairs, there were 136 surgeons, 306 surgeon-years, and 2793 operations. High Volume was defined as >14 operations per year. On regression analysis, presence of a ventriculoperitoneal shunt and surgeon laparoscopic volume was associated with recurrence risk. CONCLUSIONS:Annual surgical volume is an important determinant of recurrence following laparoscopic inguinal hernia repair. As surgeons integrate both laparoscopic and open techniques in their practice, caution should be taken to maintain adequate volume and proficiency in each technique. IRB APPROVAL:This study was IRB reviewed and approved (IRB 22-350). LEVEL OF EVIDENCE:III.