Pub Date : 2026-01-03DOI: 10.1016/j.jpedsurg.2025.162915
Nicholas J. Larson , Rachael Rivard , Blaise Boyle , Ella Chrenka , David J. Dries , Benoit Blondeau , Barbara A. Gaines , Frederick B. Rogers
Background
It is well documented that houseless patients tend to have worse medical outcomes; however, the interaction between housing status and traumatic injury, particularly in pediatric patients, is not well-understood. In this study we sought to identify if houseless patients have greater morbidity and mortality after trauma utilizing the years 2022–2023 of the Trauma Quality Improvement Program (TQIP) database.
Methods
We conducted a case-control study utilizing years 2022–2023 of the TQIP database, matching pediatric houseless patients in a 1:3 proportion to housed patients by admission year, age, sex, and ISS. Multinomial logistic regression modeled the relationship between housing status and discharge disposition, and structured generalized linear mixed models assessed differences in length of stay and likelihood of any hospital complication.
Results
453 houseless patients were compared to 1359 controls. Significantly more houseless patients died (5.7 %) compared to controls (3.7 %). On multivariable analysis, houseless patients had over double the likelihood of death compared to discharge home (aOR 2.19), 58 % greater odds of transfer for additional care (aOR 1.58), with no significant difference in complications or resource utilization (LOS, ICU LOS, ventilator days). Identifying as a person of color doubled the odds of mortality (aOR 2.01) and increased odds of hospital complications by 76 % (aOR 1.76).
Conclusions
Caring for pediatric houseless patients presents a difficult balance between treating physical injuries while addressing social issues. Addressing the increased odds of mortality after trauma among the houseless children described in this report begins with funding social programs dedicated to preventing houselessness in the community.
{"title":"Impact of pediatric housing status and racial profile on outcomes after traumatic injury","authors":"Nicholas J. Larson , Rachael Rivard , Blaise Boyle , Ella Chrenka , David J. Dries , Benoit Blondeau , Barbara A. Gaines , Frederick B. Rogers","doi":"10.1016/j.jpedsurg.2025.162915","DOIUrl":"10.1016/j.jpedsurg.2025.162915","url":null,"abstract":"<div><h3>Background</h3><div>It is well documented that houseless patients tend to have worse medical outcomes; however, the interaction between housing status and traumatic injury, particularly in pediatric patients, is not well-understood. In this study we sought to identify if houseless patients have greater morbidity and mortality after trauma utilizing the years 2022–2023 of the Trauma Quality Improvement Program (TQIP) database.</div></div><div><h3>Methods</h3><div>We conducted a case-control study utilizing years 2022–2023 of the TQIP database, matching pediatric houseless patients in a 1:3 proportion to housed patients by admission year, age, sex, and ISS. Multinomial logistic regression modeled the relationship between housing status and discharge disposition, and structured generalized linear mixed models assessed differences in length of stay and likelihood of any hospital complication.</div></div><div><h3>Results</h3><div>453 houseless patients were compared to 1359 controls. Significantly more houseless patients died (5.7 %) compared to controls (3.7 %). On multivariable analysis, houseless patients had over double the likelihood of death compared to discharge home (aOR 2.19), 58 % greater odds of transfer for additional care (aOR 1.58), with no significant difference in complications or resource utilization (LOS, ICU LOS, ventilator days). Identifying as a person of color doubled the odds of mortality (aOR 2.01) and increased odds of hospital complications by 76 % (aOR 1.76).</div></div><div><h3>Conclusions</h3><div>Caring for pediatric houseless patients presents a difficult balance between treating physical injuries while addressing social issues. Addressing the increased odds of mortality after trauma among the houseless children described in this report begins with funding social programs dedicated to preventing houselessness in the community.</div></div><div><h3>Study Type</h3><div>Prognostic and Epidemiological; Level IV.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 3","pages":"Article 162915"},"PeriodicalIF":2.5,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145906236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To explore the clinical efficacy of surgical progressive individualized treatment for corrosive esophageal stricture in children.
Methods
A retrospective analysis was conducted on the medical records of 52 children with corrosive esophageal stricture who were treated and followed up regularly in the Department of Cardiothoracic Surgery, Children's Hospital Affiliated to Nanjing Medical University from January 2017 to December 2024, including 30 males and 22 females, with an age of (4.20 ± 0.81) years and a weight of (12.20 ± 1.35) kg. There were 18 cases of acid substance ingestion, 31 cases of alkaline substance ingestion, and 3 cases of button battery ingestion. Sequential treatment methods including gastroscopic balloon dilation under direct vision, balloon dilation combined with submucosal injection of Mitomycin C into the esophagus, esophageal stent placement, and esophageal reconstruction were applied for the treatment of corrosive esophageal stricture in children. Postoperatively, the degree of esophageal stricture was observed via esophagography and gastroscopy, and the clinical efficacy of the surgical progressive treatment was evaluated in combination with the children's dysphagia grade. The t-test or chi-square test was used for difference comparison.
Results
All 52 children were discharged successfully. All children underwent balloon dilation treatment, among which 22 cases treated with simple gastroscopic balloon dilation under direct vision achieved good results; 30 cases received balloon dilation combined with submucosal injection of Mitomycin C into the esophagus, of which 16 cases achieved good results and 14 cases underwent esophageal stent placement; 14 cases underwent esophageal stent placement, of which 9 cases achieved good results and 5 cases underwent surgical treatment with good results.
Conclusion
The progressive individualized methods of gastroscopic balloon dilation under direct vision, balloon dilation combined with submucosal injection of Mitomycin C into the esophagus, esophageal stent placement, and esophageal reconstruction have definite clinical effects in the treatment of corrosive esophageal stricture in children, with simple methods that are easy to operate and promote.
{"title":"Analysis of clinical efficacy of surgical progressive treatment for corrosive esophageal stricture in children","authors":"Yuzhong Yang, Yong Chen, Lina Cai, Jirong Qi, Zhiqi Wang, Xuming Mo","doi":"10.1016/j.jpedsurg.2025.162891","DOIUrl":"10.1016/j.jpedsurg.2025.162891","url":null,"abstract":"<div><h3>Objective</h3><div>To explore the clinical efficacy of surgical progressive individualized treatment for corrosive esophageal stricture in children.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on the medical records of 52 children with corrosive esophageal stricture who were treated and followed up regularly in the Department of Cardiothoracic Surgery, Children's Hospital Affiliated to Nanjing Medical University from January 2017 to December 2024, including 30 males and 22 females, with an age of (4.20 ± 0.81) years and a weight of (12.20 ± 1.35) kg. There were 18 cases of acid substance ingestion, 31 cases of alkaline substance ingestion, and 3 cases of button battery ingestion. Sequential treatment methods including gastroscopic balloon dilation under direct vision, balloon dilation combined with submucosal injection of Mitomycin C into the esophagus, esophageal stent placement, and esophageal reconstruction were applied for the treatment of corrosive esophageal stricture in children. Postoperatively, the degree of esophageal stricture was observed via esophagography and gastroscopy, and the clinical efficacy of the surgical progressive treatment was evaluated in combination with the children's dysphagia grade. The t-test or chi-square test was used for difference comparison.</div></div><div><h3>Results</h3><div>All 52 children were discharged successfully. All children underwent balloon dilation treatment, among which 22 cases treated with simple gastroscopic balloon dilation under direct vision achieved good results; 30 cases received balloon dilation combined with submucosal injection of Mitomycin C into the esophagus, of which 16 cases achieved good results and 14 cases underwent esophageal stent placement; 14 cases underwent esophageal stent placement, of which 9 cases achieved good results and 5 cases underwent surgical treatment with good results.</div></div><div><h3>Conclusion</h3><div>The progressive individualized methods of gastroscopic balloon dilation under direct vision, balloon dilation combined with submucosal injection of Mitomycin C into the esophagus, esophageal stent placement, and esophageal reconstruction have definite clinical effects in the treatment of corrosive esophageal stricture in children, with simple methods that are easy to operate and promote.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 4","pages":"Article 162891"},"PeriodicalIF":2.5,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145900807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jpedsurg.2025.162524
Paulo Castro , Anna M. Lin , Lindsey Asti , Loren Berman , Matthew Boelig
Background
This study aims to evaluate 30-day outcomes for children undergoing open versus minimally invasive surgery (MIS) for choledochal cysts using a propensity score matched cohort created from a national database.
Methods
Children undergoing surgery for choledochal cyst from 2013 to 2023 were identified using the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database. A propensity score match was performed. Outcomes were compared between operative approaches using an intention-to-treat analysis. Pearson’s chi-square, Fisher’s exact, and Mann–Whitney’s U tests were used as appropriate. A Cochran–Armitage test was used to assess operative trends.
Results
A total of 773 children who underwent surgery for choledochal cyst were identified. Pre-match, children undergoing open surgery were more likely to be younger, smaller in weight, have Roux-en-Y hepaticojejunostomy performed, have a history of gastrointestinal disease, and have higher American Society of Anesthesiology (ASA) class. Post-match, the groups were similar and included 247 cases per group. The MIS approach was associated with a longer median operative time (311 min vs. 261 mins, p < 0.001) and more surgical site infections (SSI) (6.5 % vs. 1.6 %, p = 0.006). There were no differences in composite morbidity, postoperative length of stay, and readmission or reoperation at 30 days. MIS utilization increased over the study period (p < 0.001).
Conclusions
MIS utilization has steadily increased within the NSQIP-P cohort. The MIS approach takes longer to perform and may be associated with a higher rate of SSIs. We observed no significant differences in overall morbidity, postoperative length of stay, readmission, or reoperation. Multicenter prospective trials would be useful to further compare these two approaches.
{"title":"Open versus minimally invasive surgery for pediatric choledochal cyst in a propensity score matched cohort","authors":"Paulo Castro , Anna M. Lin , Lindsey Asti , Loren Berman , Matthew Boelig","doi":"10.1016/j.jpedsurg.2025.162524","DOIUrl":"10.1016/j.jpedsurg.2025.162524","url":null,"abstract":"<div><h3>Background</h3><div>This study aims to evaluate 30-day outcomes for children undergoing open versus minimally invasive surgery (MIS) for choledochal cysts using a propensity score matched cohort created from a national database.</div></div><div><h3>Methods</h3><div>Children undergoing surgery for choledochal cyst from 2013 to 2023 were identified using the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database. A propensity score match was performed. Outcomes were compared between operative approaches using an intention-to-treat analysis. Pearson’s chi-square, Fisher’s exact, and Mann–Whitney’s U tests were used as appropriate. A Cochran–Armitage test was used to assess operative trends.</div></div><div><h3>Results</h3><div>A total of 773 children who underwent surgery for choledochal cyst were identified. Pre-match, children undergoing open surgery were more likely to be younger, smaller in weight, have Roux-en-Y hepaticojejunostomy performed, have a history of gastrointestinal disease, and have higher American Society of Anesthesiology (ASA) class. Post-match, the groups were similar and included 247 cases per group. The MIS approach was associated with a longer median operative time (311 min vs. 261 mins, <em>p</em> < 0.001) and more surgical site infections (SSI) (6.5 % vs. 1.6 %, <em>p</em> = 0.006). There were no differences in composite morbidity, postoperative length of stay, and readmission or reoperation at 30 days. MIS utilization increased over the study period (<em>p</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>MIS utilization has steadily increased within the NSQIP-P cohort. The MIS approach takes longer to perform and may be associated with a higher rate of SSIs. We observed no significant differences in overall morbidity, postoperative length of stay, readmission, or reoperation. Multicenter prospective trials would be useful to further compare these two approaches.</div></div><div><h3>Type of study</h3><div>Retrospective comparative study.</div></div><div><h3>Level of Evidence</h3><div>Level III.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 1","pages":"Article 162524"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jpedsurg.2025.162536
Ava Herzog , Aditya Goyal , Ashar Ata , Rebecca Brocks , Mary J. Edwards
Purpose
Large studies describing outcomes for surgical plication for diaphragmatic eventration (DE) are lacking, and optimal timing of surgery for symptomatic patients is not known. We aimed to assess outcomes of pediatric diaphragmatic plication in a large cohort and assess the impact of prematurity and gestational age at surgery (GAS).
Methods
The NSQIP pediatric file was queried for diaphragmatic plication (2016–2022). Outcomes included major complications, mortality, hospital stay, and ventilator days. ANOVA and Chi square tests compared outcomes by GAS, with multivariable regression assessing independent effects of GAS and prematurity.
Results
252 children underwent plication; 18 % were premature, 27 % had a GAS under 44 weeks, and 26 % between 44 and 60 weeks. Prematurity was associated with major complications (41 % vs 19 % p < 0.0001), post-operative ventilation (40 % vs 20 % p < 0.001), prolonged ventilator days, and oxygen use at discharge (40 % vs 18 % p < 0.001). Early GAS was significantly associated with major complications (39 % < 44 weeks, 31 % 44–60 weeks, 2 % 60–90 weeks, 10 % 90–200 weeks, 14 % > 200 weeks) and prolonged hospitalization. Multivariable adjustment for ASA class and operative approach demonstrated early GAS and prematurity independently predicted major complications and increased hospital days, with GAS being a stronger predictor for both.
Conclusions
Complications after diaphragmatic plication in infants are common, particularly those with a history of prematurity. Early GAS is a strong predictor of post-operative morbidity and extended hospital stay and should be considered in timing surgical intervention.
目的：目前缺乏描述手术治疗膈肌膨出（DE）效果的大型研究，对有症状患者的最佳手术时机尚不清楚。我们的目的是在一个大队列中评估儿童膈肌应用的结果，并评估手术时早产和胎龄（GAS）的影响。方法：查询NSQIP小儿膈肌应用档案（2016-2022）。结果包括主要并发症、死亡率、住院时间和呼吸机天数。方差分析和卡方检验比较了GAS的结果，多变量回归评估了GAS和早产的独立影响。结果：252例患儿接受应用；18%早产，27%在44周以下，26%在44-60周之间。早产与主要并发症（41% vs 19%）和住院时间延长有关。ASA分级和手术方式的多变量调整表明，早期GAS和早产独立预测主要并发症和住院天数增加，GAS是两者的更强预测因子。结论：婴儿膈肌应用术后的并发症是常见的，特别是那些有早产史的婴儿。早期GAS是术后发病率和住院时间延长的一个强有力的预测指标，在选择手术干预时机时应予以考虑。
{"title":"Impact of prematurity and gestational age at surgery on diaphragmatic plication outcomes","authors":"Ava Herzog , Aditya Goyal , Ashar Ata , Rebecca Brocks , Mary J. Edwards","doi":"10.1016/j.jpedsurg.2025.162536","DOIUrl":"10.1016/j.jpedsurg.2025.162536","url":null,"abstract":"<div><h3>Purpose</h3><div>Large studies describing outcomes for surgical plication for diaphragmatic eventration (DE) are lacking, and optimal timing of surgery for symptomatic patients is not known. We aimed to assess outcomes of pediatric diaphragmatic plication in a large cohort and assess the impact of prematurity and gestational age at surgery (GAS).</div></div><div><h3>Methods</h3><div>The NSQIP pediatric file was queried for diaphragmatic plication (2016–2022). Outcomes included major complications, mortality, hospital stay, and ventilator days. ANOVA and Chi square tests compared outcomes by GAS, with multivariable regression assessing independent effects of GAS and prematurity.</div></div><div><h3>Results</h3><div>252 children underwent plication; 18 % were premature, 27 % had a GAS under 44 weeks, and 26 % between 44 and 60 weeks. Prematurity was associated with major complications (41 % vs 19 % p < 0.0001), post-operative ventilation (40 % vs 20 % p < 0.001), prolonged ventilator days, and oxygen use at discharge (40 % vs 18 % p < 0.001). Early GAS was significantly associated with major complications (39 % < 44 weeks, 31 % 44–60 weeks, 2 % 60–90 weeks, 10 % 90–200 weeks, 14 % > 200 weeks) and prolonged hospitalization. Multivariable adjustment for ASA class and operative approach demonstrated early GAS and prematurity independently predicted major complications and increased hospital days, with GAS being a stronger predictor for both.</div></div><div><h3>Conclusions</h3><div>Complications after diaphragmatic plication in infants are common, particularly those with a history of prematurity. Early GAS is a strong predictor of post-operative morbidity and extended hospital stay and should be considered in timing surgical intervention.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 1","pages":"Article 162536"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jpedsurg.2025.162541
Anastasia M. Kahan , Lorraine I. Kelley-Quon , Shannon N. Acker , Sage Vincent , Stephanie D. Chao , Helene Nepomuceno , Justin H. Lee , Benjamin E. Padilla , Utsav M. Patwardhan , Gerald Gollin , Romeo C. Ignacio , Elizabeth A. Fialkowski , Kathryn L. Fowler , Sarah B. Cairo , Dane Munar , Samir R. Pandya , Katie W. Russell , Stephen J. Fenton , Steven L. Lee , David H. Rothstein
Purpose
Pleural drains are used routinely after thoracic surgery in children despite evidence that drainage is not always necessary. The purpose of this study was to assess the necessity of intraoperative drain placement after resectional lung surgery in children, provide a contemporary characterization of the use of pleural drains, and evaluate the utility of intraoperative air leak testing.
Methods
A multi-institutional prospective cohort study was performed at 10 free-standing children's hospitals in the United States from 2023 to 2024. Patients ≤18 years old who underwent open or thoracoscopic wedge resection or lobectomy were included. Patients undergoing operation for spontaneous pneumothorax or trauma, those on extra-corporeal life support, those undergoing bi-lobectomy or pneumonectomy, and those undergoing reoperation in the affected hemithorax were excluded. Operative parameters, intra-operative air leak, length of post-operative drain placement, and number of post-operative chest x-rays were evaluated using bivariate comparisons.
Results
Among 229 patients (58% male, median age 12.3 years [IQR 5–16]), 113 (49%) underwent wedge resection and the remaining 116 (51%) underwent lobectomy. 201 patients (87.8%) had a pleural drain vs 28 (12.2%) without. Air leak testing was performed for 198 children: among those with a negative leak test (168, 73.4%), 144 (85.7%) had a pleural drain placed. Of the 90 children undergoing wedge resection with air leak test results available, 78 (87%) had a negative leak test and 57 (73%) of those patients still received pleural drainage. None of the 28 cases initially without pleural drainage required post-operative insertion of a pleural drain. Children with pleural drainage had significantly more post-operative chest x-rays compared to those without (median 5 vs 2, p < 0.001), and a significantly longer post-operative length of stay (median 3 vs 1 days, p < 0.001).
Conclusion
Pleural drain placement after lung resection in pediatric patients is routine but may not be necessary. Patients with pleural drain incur significantly higher postoperative radiation exposure compared to those without. Randomized control trials of pleural drainage after resectional lung surgery are needed to examine further if the routine use of pleural drainage is necessary.
{"title":"Pleural drain placement following lung resection in children: A prospective observational study of the Western Pediatric Surgery Research Consortium","authors":"Anastasia M. Kahan , Lorraine I. Kelley-Quon , Shannon N. Acker , Sage Vincent , Stephanie D. Chao , Helene Nepomuceno , Justin H. Lee , Benjamin E. Padilla , Utsav M. Patwardhan , Gerald Gollin , Romeo C. Ignacio , Elizabeth A. Fialkowski , Kathryn L. Fowler , Sarah B. Cairo , Dane Munar , Samir R. Pandya , Katie W. Russell , Stephen J. Fenton , Steven L. Lee , David H. Rothstein","doi":"10.1016/j.jpedsurg.2025.162541","DOIUrl":"10.1016/j.jpedsurg.2025.162541","url":null,"abstract":"<div><h3>Purpose</h3><div>Pleural drains are used routinely after thoracic surgery in children despite evidence that drainage is not always necessary. The purpose of this study was to assess the necessity of intraoperative drain placement after resectional lung surgery in children, provide a contemporary characterization of the use of pleural drains, and evaluate the utility of intraoperative air leak testing.</div></div><div><h3>Methods</h3><div>A multi-institutional prospective cohort study was performed at 10 free-standing children's hospitals in the United States from 2023 to 2024. Patients ≤18 years old who underwent open or thoracoscopic wedge resection or lobectomy were included. Patients undergoing operation for spontaneous pneumothorax or trauma, those on extra-corporeal life support, those undergoing bi-lobectomy or pneumonectomy, and those undergoing reoperation in the affected hemithorax were excluded. Operative parameters, intra-operative air leak, length of post-operative drain placement, and number of post-operative chest x-rays were evaluated using bivariate comparisons.</div></div><div><h3>Results</h3><div>Among 229 patients (58% male, median age 12.3 years [IQR 5–16]), 113 (49%) underwent wedge resection and the remaining 116 (51%) underwent lobectomy. 201 patients (87.8%) had a pleural drain vs 28 (12.2%) without. Air leak testing was performed for 198 children: among those with a negative leak test (168, 73.4%), 144 (85.7%) had a pleural drain placed. Of the 90 children undergoing wedge resection with air leak test results available, 78 (87%) had a negative leak test and 57 (73%) of those patients still received pleural drainage. None of the 28 cases initially without pleural drainage required post-operative insertion of a pleural drain. Children with pleural drainage had significantly more post-operative chest x-rays compared to those without (median 5 vs 2, p < 0.001), and a significantly longer post-operative length of stay (median 3 vs 1 days, p < 0.001).</div></div><div><h3>Conclusion</h3><div>Pleural drain placement after lung resection in pediatric patients is routine but may not be necessary. Patients with pleural drain incur significantly higher postoperative radiation exposure compared to those without. Randomized control trials of pleural drainage after resectional lung surgery are needed to examine further if the routine use of pleural drainage is necessary.</div></div><div><h3>Level of evidence</h3><div>III.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 1","pages":"Article 162541"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144821618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jpedsurg.2025.162603
Megan A. Read , Brenna Rachwal , Liese C.C. Pruitt , Andrew C. Sager , Alessandra C. Gasior , Ihab Halaweish , Richard J. Wood
Purpose
Anastomotic stricture leads to significant post-operative morbidity for patients with anorectal malformations (ARM) and Hirschsprung Disease (HSCR). The injection of the long-acting steroid triamcinolone acetonide (TAC) after stricture dilation has been shown to decrease stricture recurrence and interventions needed to achieve resolution but has yet to be studied in patients with ARM or HSCR.
Methods
We performed a single-institution retrospective review of patients with ARM or HSCR who underwent TAC injection with dilation for anastomotic stricture. Clinical history, procedural details, and post-injection outcomes were assessed.
Results
From 2018 to 2024, 50 patients, 30 with ARM and 20 with HSCR, underwent dilation of anastomotic stricture followed by TAC injection. Stricture resolution was observed in 21 patients (70.0 %) with ARM and 17 patients with HSCR (85.0 %) after dilation with TAC injection. The median number of injections to achieve resolution was 1 in both groups, with a maximum of 5 in both diagnosis groups. Nine patients (30.0 %) with ARM and 2 with HSCR (10.0 %) ultimately required surgery to achieve resolution. There were no significant differences in clinical characteristics between those who required surgery and those who did not within each diagnosis group. There were no intraoperative complications; 30-day complication rate was 2.2 %.
Conclusions
Injection of TAC as an addition to dilation of post-operative stricture is a safe, minimally invasive approach to stricture management. The outcomes for our patients with ARM and HSCR are promising, and we plan for additional prospective study to further explore the benefits.
{"title":"Safety and utility of long-acting steroid injection for management of post-operative stricture in patients with anorectal malformation and Hirschsprung Disease","authors":"Megan A. Read , Brenna Rachwal , Liese C.C. Pruitt , Andrew C. Sager , Alessandra C. Gasior , Ihab Halaweish , Richard J. Wood","doi":"10.1016/j.jpedsurg.2025.162603","DOIUrl":"10.1016/j.jpedsurg.2025.162603","url":null,"abstract":"<div><h3>Purpose</h3><div>Anastomotic stricture leads to significant post-operative morbidity for patients with anorectal malformations (ARM) and Hirschsprung Disease (HSCR). The injection of the long-acting steroid triamcinolone acetonide (TAC) after stricture dilation has been shown to decrease stricture recurrence and interventions needed to achieve resolution but has yet to be studied in patients with ARM or HSCR.</div></div><div><h3>Methods</h3><div>We performed a single-institution retrospective review of patients with ARM or HSCR who underwent TAC injection with dilation for anastomotic stricture. Clinical history, procedural details, and post-injection outcomes were assessed.</div></div><div><h3>Results</h3><div>From 2018 to 2024, 50 patients, 30 with ARM and 20 with HSCR, underwent dilation of anastomotic stricture followed by TAC injection. Stricture resolution was observed in 21 patients (70.0 %) with ARM and 17 patients with HSCR (85.0 %) after dilation with TAC injection. The median number of injections to achieve resolution was 1 in both groups, with a maximum of 5 in both diagnosis groups. Nine patients (30.0 %) with ARM and 2 with HSCR (10.0 %) ultimately required surgery to achieve resolution. There were no significant differences in clinical characteristics between those who required surgery and those who did not within each diagnosis group. There were no intraoperative complications; 30-day complication rate was 2.2 %.</div></div><div><h3>Conclusions</h3><div>Injection of TAC as an addition to dilation of post-operative stricture is a safe, minimally invasive approach to stricture management. The outcomes for our patients with ARM and HSCR are promising, and we plan for additional prospective study to further explore the benefits.</div></div><div><h3>Type of Study</h3><div>Retrospective Study.</div></div><div><h3>Level of Evidence</h3><div>IV.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 1","pages":"Article 162603"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jpedsurg.2025.162519
William J. Kacey , Daniel R. Liesman , Ashley C. Dodd , Steven T. Papastefan , Kalvin C. Lung , Seth D. Goldstein , Timothy B. Lautz
Purpose
Pulmonary nodule localization is essential for many procedures in children with cancer. Shape-sensing robotic-assisted bronchoscopy (ssRAB) is a preferred modality of nodule biopsy and localization in adult thoracic surgery, but its utility in pediatric surgery is unknown. We examined the feasibility of ssRAB including bronchial tree mapping and nodule localization in children.
Methods
We identified 14 pulmonary nodules in 11 patients aged 2–18 years on CT scans from 2021 to 2023. We created an additional 34 nodules in an expansion cohort from 17 patients aged 11-months to 17-years to increase sample size. Nodules were categorized as central or peripheral. Bronchoscopy routes were generated with target-to-lesion distance and airway diameter recorded. If the target-to-lesion was greater than 30 mm or airway diameter less than 3 mm, the pathway was manually adjusted. If after manual adjustment the parameters were not met then the pathway was unfeasible.
Results
Of the 11 patients with the existing nodules, 66 % of peripheral nodules (8/12) and 100 % of central nodules (2/2) were feasibly mapped. When examining the feasibility of the expansion cohort 65 % of peripheral nodules (11/17) and 100 % of central nodules (17/17) were mapped. When comparing feasible and unfeasible nodules, there was no difference in patient age and tracheal diameter.
Conclusions
Given the success of our bronchial tree mapping and nodule identification, we conclude that ssRAB is a feasible approach to biopsy and pulmonary nodule localization in children. Peripheral location not age was detrimental to successful mapping. Trialing ssRAB for pediatric lung nodule localization is likely feasible.
{"title":"Assessing the feasibility of shape-sensing robotic bronchoscopy mapping to lung nodules in pediatric patients","authors":"William J. Kacey , Daniel R. Liesman , Ashley C. Dodd , Steven T. Papastefan , Kalvin C. Lung , Seth D. Goldstein , Timothy B. Lautz","doi":"10.1016/j.jpedsurg.2025.162519","DOIUrl":"10.1016/j.jpedsurg.2025.162519","url":null,"abstract":"<div><h3>Purpose</h3><div>Pulmonary nodule localization is essential for many procedures in children with cancer. Shape-sensing robotic-assisted bronchoscopy (ssRAB) is a preferred modality of nodule biopsy and localization in adult thoracic surgery, but its utility in pediatric surgery is unknown. We examined the feasibility of ssRAB including bronchial tree mapping and nodule localization in children.</div></div><div><h3>Methods</h3><div>We identified 14 pulmonary nodules in 11 patients aged 2–18 years on CT scans from 2021 to 2023. We created an additional 34 nodules in an expansion cohort from 17 patients aged 11-months to 17-years to increase sample size. Nodules were categorized as central or peripheral. Bronchoscopy routes were generated with target-to-lesion distance and airway diameter recorded. If the target-to-lesion was greater than 30 mm or airway diameter less than 3 mm, the pathway was manually adjusted. If after manual adjustment the parameters were not met then the pathway was unfeasible.</div></div><div><h3>Results</h3><div>Of the 11 patients with the existing nodules, 66 % of peripheral nodules (8/12) and 100 % of central nodules (2/2) were feasibly mapped. When examining the feasibility of the expansion cohort 65 % of peripheral nodules (11/17) and 100 % of central nodules (17/17) were mapped. When comparing feasible and unfeasible nodules, there was no difference in patient age and tracheal diameter.</div></div><div><h3>Conclusions</h3><div>Given the success of our bronchial tree mapping and nodule identification, we conclude that ssRAB is a feasible approach to biopsy and pulmonary nodule localization in children. Peripheral location not age was detrimental to successful mapping. Trialing ssRAB for pediatric lung nodule localization is likely feasible.</div></div><div><h3>Type of Study</h3><div>Feasibility Study.</div></div><div><h3>Level of Evidence</h3><div>Level IV.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 1","pages":"Article 162519"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jpedsurg.2025.162522
Zane J. Hellmann , Alexis Jones , Carly Thaxton , Katherine Bergus , Amelia Mansfield , Daniel G. Solomon , Sara Mansfield , Emily R. Christison-Lagay
Introduction
Driving speed can be statutorily controlled through speed limits, but also modulated through changes to the built environment. Increasing intersection density has previously been shown to lower driving speeds.
Methods
The Ohio Department of Transportation collision dataset was queried for all pedestrians/cyclists younger than 18 years, who were struck by a motor vehicle between 2020 and 2024. Records were matched to admissions at five pediatric hospitals in Ohio. Each collision was mapped to a census tract. Intersections per square mile were derived from the National Walk Index. Primary outcome was mean calculated injury severity score (ISS), as derived from ICD-10 diagnostic codes.
Results
There were 2544 pedestrians/cyclists struck by a motor vehicle, 405 of whom (15.9 %) were matched to encounters at a children's hospital in Ohio. Median calculated ISS was 4 (IQR 1–5). Multivariate Poisson regression demonstrated that for each additional 10 intersections per square mile there was an 1 % reduction in ISS (IRR 0.99, 95 % CI 0.98–0.997, p = 0.01). Children struck in active school zones had significantly lower ISS (IRR 0.64, 95 % CI 0.47–0.89, p < 0.01).
Conclusion
When pediatric pedestrians are struck by a motor vehicle, those occurring in areas with high intersection density or active school zones correlated with lower ISS. This highlights tangible local policy changes—including increased crosswalks, expanded school zones, and roadway designs to slow traffic and improved street lighting—that could be implemented to decrease the severity of injuries in struck pediatric pedestrians.
导言：驾驶速度可以通过限速进行法定控制，但也可以通过改变建筑环境进行调节。之前的研究表明，增加路口密度会降低驾驶速度。方法：查询俄亥俄州交通部碰撞数据集，其中包括2020-2024年期间被机动车撞击的所有18岁以下行人/骑自行车的人。记录与俄亥俄州五家儿科医院的入院记录相匹配。每次碰撞都被映射到一个人口普查区。每平方英里十字路口的数据来源于国家步行指数。主要结局是根据ICD-10诊断代码计算的平均损伤严重程度评分（ISS）。结果：有2544名行人/骑自行车的人被机动车撞倒，其中405人（15.9%）与俄亥俄州儿童医院的遭遇相匹配。计算的ISS中位数为4 （IQR 1-5）。多元泊松回归表明，每平方英里每增加10个十字路口，ISS减少1% （IRR 0.99, 95% CI 0.98-0.997, p=0.01）。结论：当儿童行人被机动车撞击时，发生在十字路口密度高的地区或发生在活跃的学校区域的事故与较低的ISS相关。这突出了切实可行的地方政策变化，包括增加人行横道、扩大学区、设计道路以减缓交通和改善街道照明，这些都可以实施，以减少儿童行人受伤的严重程度。
{"title":"Why did the children cross the road? The relationship between roadway design and severe pediatric trauma in pedestrians struck by motor vehicle","authors":"Zane J. Hellmann , Alexis Jones , Carly Thaxton , Katherine Bergus , Amelia Mansfield , Daniel G. Solomon , Sara Mansfield , Emily R. Christison-Lagay","doi":"10.1016/j.jpedsurg.2025.162522","DOIUrl":"10.1016/j.jpedsurg.2025.162522","url":null,"abstract":"<div><h3>Introduction</h3><div>Driving speed can be statutorily controlled through speed limits, but also modulated through changes to the built environment. Increasing intersection density has previously been shown to lower driving speeds.</div></div><div><h3>Methods</h3><div>The Ohio Department of Transportation collision dataset was queried for all pedestrians/cyclists younger than 18 years, who were struck by a motor vehicle between 2020 and 2024. Records were matched to admissions at five pediatric hospitals in Ohio. Each collision was mapped to a census tract. Intersections per square mile were derived from the National Walk Index. Primary outcome was mean calculated injury severity score (ISS), as derived from ICD-10 diagnostic codes.</div></div><div><h3>Results</h3><div>There were 2544 pedestrians/cyclists struck by a motor vehicle, 405 of whom (15.9 %) were matched to encounters at a children's hospital in Ohio. Median calculated ISS was 4 (IQR 1–5). Multivariate Poisson regression demonstrated that for each additional 10 intersections per square mile there was an 1 % reduction in ISS (IRR 0.99, 95 % CI 0.98–0.997, p = 0.01). Children struck in active school zones had significantly lower ISS (IRR 0.64, 95 % CI 0.47–0.89, p < 0.01).</div></div><div><h3>Conclusion</h3><div>When pediatric pedestrians are struck by a motor vehicle, those occurring in areas with high intersection density or active school zones correlated with lower ISS. This highlights tangible local policy changes—including increased crosswalks, expanded school zones, and roadway designs to slow traffic and improved street lighting—that could be implemented to decrease the severity of injuries in struck pediatric pedestrians.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 1","pages":"Article 162522"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jpedsurg.2025.162596
Andreina Giron , Zoe E. Flyer , Ana Maria Dumitru , Hira Ahmad , Laura F. Goodman , Jeffry Nahmias , Peter T. Yu , John Schomberg
Introduction
Historically, fecal diversion via proximal stoma (PS) was an accepted option for pediatric colorectal trauma, but recent studies have suggested primary anastomosis (PA) to be safe. This study aimed to compare outcomes between PS and PA for pediatric colorectal trauma, hypothesizing PS will be associated with increased complications but lower mortality compared to PA in this population.
Methods
A retrospective study using the National Trauma Data Bank (2018–2022) was conducted. Patients ≤18 years old with colon and/or rectal injury who underwent either PS or PA were included. PS was defined as fecal diversion using a stoma proximal to the colorectal injury; PA was defined as any colon and/or rectal anastomosis without proximal fecal diversion. Descriptive statistics, Kaplan–Meier curves and logistic regression were performed to compare outcomes.
Results
A total of 3511 pediatric patients met inclusion criteria; 548 (15.6 %) underwent PS and 2963 (84.4 %) underwent PA. Demographics were similar between groups, though PS patients had higher median ISS (17 vs. 16, p = 0.0003) and more rectal injuries (46.7 % vs. 8.2 %, p < 0.0001). PS was associated with longer ICU (median 5 vs. 4 days, p < 0.0001) and total hospital stays (median 12 vs. 8 days, p < 0.0001), and higher rates of deep space SSI (2.4 % vs. 1.6 %, p = 0.05), return to OR (8.8 % vs. 4.7 %, p = 0.003), and mechanical ventilation use (41.9 % vs. 35.7 %, p = 0.006). Unadjusted mortality was lower with PS (2.6 % vs. 5.4 %, p = 0.0007), but multivariable analysis showed no mortality difference by diversion type; instead, colonic resection/excision independently increased mortality risk (OR 1.02, 95 % CI 1.00–1.05, p = 0.04). Kaplan–Meier analysis demonstrated higher survival with PS only in rectal injuries and in patients without resection, with no survival difference in other anatomic sites or among resection cases.
Conclusions
Despite longer hospitalizations and higher complication rates, PS patients demonstrated lower unadjusted mortality compared to PA. However, after adjustment, diversion type was not independently associated with mortality, and the need for colonic resection/excision emerged as a more important predictor of death. These findings suggest that previously observed survival advantages with PS may be driven by underlying injury severity and operative factors rather than diversion status alone. Prospective studies are warranted to clarify optimal surgical management for pediatric colorectal trauma, particularly in high-risk subgroups.
Level of evidence
III.
历史上，通过近端造口（PS）转移粪便是儿童结肠直肠创伤的一种可接受的选择，但最近的研究表明，初级吻合（PA）是安全的。本研究旨在比较PS和PA治疗儿童结直肠创伤的结果，假设在这一人群中，PS与并发症增加有关，但与PA相比死亡率较低。方法：利用国家创伤数据库（2018-2022）进行回顾性研究。≤18岁的结肠和/或直肠损伤患者接受了PS或PA。PS定义为使用结肠损伤近端造口进行粪便转移；PA定义为任何结肠和/或直肠吻合而没有近端粪便分流。采用描述性统计、Kaplan-Meier曲线和logistic回归对结果进行比较。结果：共有3511例儿科患者符合纳入标准；548例（15.6%）行PS， 2963例（84.4%）行PA。两组之间的人口统计学相似，但PS患者的中位ISS较高（17比16，p = 0.0003），直肠损伤较多（46.7%比8.2%,p < 0.0001）。PS与ICU时间较长（中位5天vs. 4天，p < 0.0001）和总住院时间（中位12天vs. 8天，p < 0.0001）、深空SSI发生率（2.4% vs. 1.6%, p = 0.05）、OR复发率（8.8% vs. 4.7%, p = 0.003）和机械通气使用率（41.9% vs. 35.7%, p = 0.006）相关。PS组的未调整死亡率较低（2.6% vs. 5.4%, p = 0.0007），但多变量分析显示不同分流类型的死亡率无差异；相反，结肠切除术/切除单独增加了死亡风险（OR 1.02, 95% CI 1.00-1.05, p = 0.04）。Kaplan-Meier分析显示，PS仅在直肠损伤和未切除的患者中生存率更高，在其他解剖部位或切除病例中生存率无差异。结论：尽管住院时间更长，并发症发生率更高，但与PA相比，PS患者的未调整死亡率更低。然而，调整后，分流类型与死亡率没有独立相关性，结肠切除/切除的需要成为更重要的死亡预测因素。这些发现表明，先前观察到的PS患者的生存优势可能是由潜在的损伤严重程度和手术因素驱动的，而不仅仅是转移状态。前瞻性研究有必要阐明小儿结直肠创伤的最佳手术治疗，特别是在高危亚组中。证据水平：III。
{"title":"Comparative outcomes of proximal stoma versus primary anastomosis in pediatric colorectal trauma","authors":"Andreina Giron , Zoe E. Flyer , Ana Maria Dumitru , Hira Ahmad , Laura F. Goodman , Jeffry Nahmias , Peter T. Yu , John Schomberg","doi":"10.1016/j.jpedsurg.2025.162596","DOIUrl":"10.1016/j.jpedsurg.2025.162596","url":null,"abstract":"<div><h3>Introduction</h3><div>Historically, fecal diversion via proximal stoma (PS) was an accepted option for pediatric colorectal trauma, but recent studies have suggested primary anastomosis (PA) to be safe. This study aimed to compare outcomes between PS and PA for pediatric colorectal trauma, hypothesizing PS will be associated with increased complications but lower mortality compared to PA in this population.</div></div><div><h3>Methods</h3><div>A retrospective study using the National Trauma Data Bank (2018–2022) was conducted. Patients ≤18 years old with colon and/or rectal injury who underwent either PS or PA were included. PS was defined as fecal diversion using a stoma proximal to the colorectal injury; PA was defined as any colon and/or rectal anastomosis without proximal fecal diversion. Descriptive statistics, Kaplan–Meier curves and logistic regression were performed to compare outcomes.</div></div><div><h3>Results</h3><div>A total of 3511 pediatric patients met inclusion criteria; 548 (15.6 %) underwent PS and 2963 (84.4 %) underwent PA. Demographics were similar between groups, though PS patients had higher median ISS (17 vs. 16, p = 0.0003) and more rectal injuries (46.7 % vs. 8.2 %, p < 0.0001). PS was associated with longer ICU (median 5 vs. 4 days, p < 0.0001) and total hospital stays (median 12 vs. 8 days, p < 0.0001), and higher rates of deep space SSI (2.4 % vs. 1.6 %, p = 0.05), return to OR (8.8 % vs. 4.7 %, p = 0.003), and mechanical ventilation use (41.9 % vs. 35.7 %, p = 0.006). Unadjusted mortality was lower with PS (2.6 % vs. 5.4 %, p = 0.0007), but multivariable analysis showed no mortality difference by diversion type; instead, colonic resection/excision independently increased mortality risk (OR 1.02, 95 % CI 1.00–1.05, p = 0.04). Kaplan–Meier analysis demonstrated higher survival with PS only in rectal injuries and in patients without resection, with no survival difference in other anatomic sites or among resection cases.</div></div><div><h3>Conclusions</h3><div>Despite longer hospitalizations and higher complication rates, PS patients demonstrated lower unadjusted mortality compared to PA. However, after adjustment, diversion type was not independently associated with mortality, and the need for colonic resection/excision emerged as a more important predictor of death. These findings suggest that previously observed survival advantages with PS may be driven by underlying injury severity and operative factors rather than diversion status alone. Prospective studies are warranted to clarify optimal surgical management for pediatric colorectal trauma, particularly in high-risk subgroups.</div></div><div><h3>Level of evidence</h3><div>III.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 1","pages":"Article 162596"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jpedsurg.2025.162592
Monique Motta , Rainya Heath , Hayley Carroll , Deep Vakil , Betsy C. Rodriguez , Azalia Avila , Holly Neville , Joshua Parreco , Tamar Levene
Introduction
Timing and approach to the surgical resection of congenital lung malformations (CLMs) in infancy are driven by severity of symptoms, potential for malignancy and infection risk. There are currently no standards to the management CLMs. Therefore, we compared practice variations for CLMs in infants throughout the US.
Methods
The Nationwide Readmissions Database for 2016–2020 was queried for all patients under 1 year of age with three different categories for timing of resection of CLM: within 4 months (early), between 4 and 6 months (intermediate), and 6–12 months (late). Outcomes included prolonged length of stay (LOS >3 days), prolonged mechanical ventilation (>96 h), blood transfusions, readmission, and mortality.
Results
Of the 615 patients included, timing of surgery was nearly evenly distributed with early surgery among 186 (30.3 %), intermediate surgery among 221 (35.9 %), and late among 208 (33.8 %) patients. Although 36 % of patients overall underwent an open procedure, this rate significantly decreased with age, 44 % in patients younger than 4 months compared to 27 % in those older than 6 months (p = 0.002). Multivariable logistic regression revealed no statistical difference between early and intermediate surgery, while late surgery was associated with a decreased risk for prolonged LOS (OR 0.41 [0.25–0.67, p < 0.001] and 30-day readmission to the same hospital (OR 0.06 [0.02–0.18, p < 0.001].
Conclusions
This study demonstrates that the timing of surgery for CLMs in children varies significantly across the US and timing of surgery may impact patient outcomes. Further research is needed to refine our understanding of the optimal timing of surgery.
婴儿期先天性肺畸形（CLMs）手术切除的时机和方法是由症状的严重程度、潜在的恶性肿瘤和感染风险决定的。目前还没有管理clm的标准。因此，我们比较了美国婴儿clm的实践变化。方法：查询2016-2020年全国再入院数据库中所有1岁以下患者的三种不同类型CLM切除术时间：4个月内（早期），4 - 6个月（中期）和6-12个月（晚期）。结果包括住院时间延长（住院时间延长3天）、机械通气时间延长（住院时间延长96小时）、输血、再入院和死亡率。结果：615例患者中，手术时间分布基本均匀，早期186例（30.3%），中期221例（35.9%），晚期208例（33.8%）。尽管36%的患者接受了开放手术，但这一比例随着年龄的增长而显著下降，小于4个月的患者为44%，大于6个月的患者为27% （p =0.002）。多变量logistic回归显示早期和中期手术无统计学差异，而晚期手术与延长LOS (OR 0.41 [0.25-0.67, p < 0.001]和30天再入院风险降低相关（OR 0.06 [0.02-0.18, p < 0.001）。结论：本研究表明，美国儿童clm的手术时机差异很大，手术时机可能会影响患者的预后。需要进一步的研究来完善我们对最佳手术时机的理解。
{"title":"Comparing the timing of surgery for congenital lung malformations in children throughout the United States","authors":"Monique Motta , Rainya Heath , Hayley Carroll , Deep Vakil , Betsy C. Rodriguez , Azalia Avila , Holly Neville , Joshua Parreco , Tamar Levene","doi":"10.1016/j.jpedsurg.2025.162592","DOIUrl":"10.1016/j.jpedsurg.2025.162592","url":null,"abstract":"<div><h3>Introduction</h3><div>Timing and approach to the surgical resection of congenital lung malformations (CLMs) in infancy are driven by severity of symptoms, potential for malignancy and infection risk. There are currently no standards to the management CLMs. Therefore, we compared practice variations for CLMs in infants throughout the US.</div></div><div><h3>Methods</h3><div>The Nationwide Readmissions Database for 2016–2020 was queried for all patients under 1 year of age with three different categories for timing of resection of CLM: within 4 months (early), between 4 and 6 months (intermediate), and 6–12 months (late). Outcomes included prolonged length of stay (LOS >3 days), prolonged mechanical ventilation (>96 h), blood transfusions, readmission, and mortality.</div></div><div><h3>Results</h3><div>Of the 615 patients included, timing of surgery was nearly evenly distributed with early surgery among 186 (30.3 %), intermediate surgery among 221 (35.9 %), and late among 208 (33.8 %) patients. Although 36 % of patients overall underwent an open procedure, this rate significantly decreased with age, 44 % in patients younger than 4 months compared to 27 % in those older than 6 months (p = 0.002). Multivariable logistic regression revealed no statistical difference between early and intermediate surgery, while late surgery was associated with a decreased risk for prolonged LOS (OR 0.41 [0.25–0.67, p < 0.001] and 30-day readmission to the same hospital (OR 0.06 [0.02–0.18, p < 0.001].</div></div><div><h3>Conclusions</h3><div>This study demonstrates that the timing of surgery for CLMs in children varies significantly across the US and timing of surgery may impact patient outcomes. Further research is needed to refine our understanding of the optimal timing of surgery.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 1","pages":"Article 162592"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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