Pub Date : 2026-01-01DOI: 10.1016/j.jpedsurg.2025.162520
R. Scott Eldredge , Benjamin E. Padilla , Anastasia M. Kahan , Lauren Nicassio , Stephanie D. Chao , Marisa Schwab , Jose Diaz-Miron , Ana Ibarra , Samir Pandya , Mark Ryan , Lauren Gillory , Justin Lee , Romeo C. Ignacio , Ben A. Keller , Jack H. Scaife , Christopher E. Clinker , Lucas A. McDuffie , Emily Byrd , David Rothstein , Lorraine I. Kelley-Quon , Katie W. Russell
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.
{"title":"Effect of activity restrictions on pectus bar displacement following minimally invasive repair of pectus excavatum - A Western Pediatric Surgery Research Consortium","authors":"R. Scott Eldredge , Benjamin E. Padilla , Anastasia M. Kahan , Lauren Nicassio , Stephanie D. Chao , Marisa Schwab , Jose Diaz-Miron , Ana Ibarra , Samir Pandya , Mark Ryan , Lauren Gillory , Justin Lee , Romeo C. Ignacio , Ben A. Keller , Jack H. Scaife , Christopher E. Clinker , Lucas A. McDuffie , Emily Byrd , David Rothstein , Lorraine I. Kelley-Quon , Katie W. Russell","doi":"10.1016/j.jpedsurg.2025.162520","DOIUrl":"10.1016/j.jpedsurg.2025.162520","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 1","pages":"Article 162520"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817004","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.2025.162542
Colton D. Wayne , Wendy Jo Svetanoff , Taylor H. Jacobs , Cindy L. McManaway , Sara A. Mansfield , Elizabeth Schneider , Brian D. Kenney , Joshua R. Watson , Gail E. Besner
Purpose
Antibiotic prophylaxis minimizes the risk of infection, but overtreatment leads to antimicrobial resistance. Adult studies suggest antibiotic prophylaxis for elective cholecystectomy may not be needed. Our quality improvement project aimed to decrease prophylactic antibiotic use for elective cholecystectomies from 100 % to ≤50 % and maintain that rate for one year.
Methods
Prior to initiation, the pre-operative orderset was modified, education was provided, and surgeon consensus was achieved. All patients undergoing elective minimally invasive (laparoscopic and robotic) cholecystectomy were included. Exclusion criteria included acute cholecystitis, immunocompromised state, or performance of a combined procedure. Compliance was measured by chart review, with feedback provided for noncompliance. The project was initiated January 2024. Data were collected for twelve months prior (1/23–12/23) and after initiation (1/24–12/24). The balancing measure was surgical site infection (SSI).
Results
Ninety patients met inclusion criteria (40 pre-protocol and 50 post-protocol). Median age at surgery was 16 years (IQR 14, 17.2). Seventy-seven (86 %) patients were female. Prior to implementation, all patients (n = 40) received prophylactic antibiotics. In the first three months post-implementation, 3/16 (19 %) received antibiotic prophylaxis (due to inadequate communication with anesthesia providers). In the subsequent nine months, 0/34 (0 %) received antibiotic prophylaxis. One (2.5 %) patient in the pre-implementation group was noted to have an SSI requiring antibiotics vs. 3 (6 %) patients in the post-implementation group (p = 0.43).
Conclusion
Use of prophylactic antibiotics for elective minimally invasive cholecystectomy decreased from 100 % to 6 % without significantly increasing the rate of SSI. Appropriately decreasing use of prophylactic antibiotics can improve antibiotic stewardship efforts.
{"title":"Reduction of prophylactic antibiotics for elective pediatric cholecystectomy: A QI initiative to promote antimicrobial stewardship","authors":"Colton D. Wayne , Wendy Jo Svetanoff , Taylor H. Jacobs , Cindy L. McManaway , Sara A. Mansfield , Elizabeth Schneider , Brian D. Kenney , Joshua R. Watson , Gail E. Besner","doi":"10.1016/j.jpedsurg.2025.162542","DOIUrl":"10.1016/j.jpedsurg.2025.162542","url":null,"abstract":"<div><h3>Purpose</h3><div>Antibiotic prophylaxis minimizes the risk of infection, but overtreatment leads to antimicrobial resistance. Adult studies suggest antibiotic prophylaxis for elective cholecystectomy may not be needed. Our quality improvement project aimed to decrease prophylactic antibiotic use for elective cholecystectomies from 100 % to ≤50 % and maintain that rate for one year.</div></div><div><h3>Methods</h3><div>Prior to initiation, the pre-operative orderset was modified, education was provided, and surgeon consensus was achieved. All patients undergoing elective minimally invasive (laparoscopic and robotic) cholecystectomy were included. Exclusion criteria included acute cholecystitis, immunocompromised state, or performance of a combined procedure. Compliance was measured by chart review, with feedback provided for noncompliance. The project was initiated January 2024. Data were collected for twelve months prior (1/23–12/23) and after initiation (1/24–12/24). The balancing measure was surgical site infection (SSI).</div></div><div><h3>Results</h3><div>Ninety patients met inclusion criteria (40 pre-protocol and 50 post-protocol). Median age at surgery was 16 years (IQR 14, 17.2). Seventy-seven (86 %) patients were female. Prior to implementation, all patients (n = 40) received prophylactic antibiotics. In the first three months post-implementation, 3/16 (19 %) received antibiotic prophylaxis (due to inadequate communication with anesthesia providers). In the subsequent nine months, 0/34 (0 %) received antibiotic prophylaxis. One (2.5 %) patient in the pre-implementation group was noted to have an SSI requiring antibiotics <em>vs.</em> 3 (6 %) patients in the post-implementation group (<em>p</em> = 0.43).</div></div><div><h3>Conclusion</h3><div>Use of prophylactic antibiotics for elective minimally invasive cholecystectomy decreased from 100 % to 6 % without significantly increasing the rate of SSI. Appropriately decreasing use of prophylactic antibiotics can improve antibiotic stewardship efforts.</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 162542"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855621","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.2025.162543
Mary Elizabeth Guerra , Brian T. Hickner , Celia D. Flores , Mary E. Fang , Charlene A. Barclay , Gabriella L. Graybill , Timothy C. Lee , Sanjeev A. Vasudevan , Sundeep G. Keswani , J. Ruben Rodriguez
Purpose
An antibiotic-only approach to managing uncomplicated appendicitis in children confers the risk of missed diagnoses of alternate pathologies. We aimed to quantify this risk in patients presenting with uncomplicated acute appendicitis at a large tertiary children's hospital and to assess contemporary perioperative clinical outcomes.
Methods
A retrospective review of patients who underwent appendectomy for uncomplicated appendicitis between January 1, 2019 and December 31, 2023 was conducted. Pathology reports and perioperative outcomes were analyzed.
Results
Among 5341 patients, 1.1 % had notable alternative pathologies including 31 occult malignancies (0.6 %) and 24 atypical infections (0.5 %). A subgroup analysis demonstrated that patients who underwent interval appendectomy were more likely to have neoplasms (5/128) than those who underwent uncomplicated acute appendectomies (3.9 % vs 0.6 %, respectively; p < 0.001). The median postoperative length of stay was 2.6 h (IQR 2.0–12.5 h). There were 182 (3.4 %) surgery-related emergency center visits post-discharge and 57 (1.1 %) surgery-related readmissions. Seventeen patients (0.3 %) required additional procedures. The negative appendectomy rate was 1.8 %.
Conclusion
A notable number of patients had alternative diagnoses made by pathologic examination, including occult malignancies and atypical infections which required further treatment. The perioperative outcomes of appendectomy were favorable, with low morbidity and a low rate of negative appendectomy. These findings underscore the diagnostic value of surgical specimen evaluation and quantify the added risk of missing alternate pathologies when offering non-operative management.
{"title":"Risk of missed diagnoses when choosing non-operative management of pediatric uncomplicated appendicitis","authors":"Mary Elizabeth Guerra , Brian T. Hickner , Celia D. Flores , Mary E. Fang , Charlene A. Barclay , Gabriella L. Graybill , Timothy C. Lee , Sanjeev A. Vasudevan , Sundeep G. Keswani , J. Ruben Rodriguez","doi":"10.1016/j.jpedsurg.2025.162543","DOIUrl":"10.1016/j.jpedsurg.2025.162543","url":null,"abstract":"<div><h3>Purpose</h3><div>An antibiotic-only approach to managing uncomplicated appendicitis in children confers the risk of missed diagnoses of alternate pathologies. We aimed to quantify this risk in patients presenting with uncomplicated acute appendicitis at a large tertiary children's hospital and to assess contemporary perioperative clinical outcomes.</div></div><div><h3>Methods</h3><div>A retrospective review of patients who underwent appendectomy for uncomplicated appendicitis between January 1, 2019 and December 31, 2023 was conducted. Pathology reports and perioperative outcomes were analyzed.</div></div><div><h3>Results</h3><div>Among 5341 patients, 1.1 % had notable alternative pathologies including 31 occult malignancies (0.6 %) and 24 atypical infections (0.5 %). A subgroup analysis demonstrated that patients who underwent interval appendectomy were more likely to have neoplasms (5/128) than those who underwent uncomplicated acute appendectomies (3.9 % vs 0.6 %, respectively; p < 0.001). The median postoperative length of stay was 2.6 h (IQR 2.0–12.5 h). There were 182 (3.4 %) surgery-related emergency center visits post-discharge and 57 (1.1 %) surgery-related readmissions. Seventeen patients (0.3 %) required additional procedures. The negative appendectomy rate was 1.8 %.</div></div><div><h3>Conclusion</h3><div>A notable number of patients had alternative diagnoses made by pathologic examination, including occult malignancies and atypical infections which required further treatment. The perioperative outcomes of appendectomy were favorable, with low morbidity and a low rate of negative appendectomy. These findings underscore the diagnostic value of surgical specimen evaluation and quantify the added risk of missing alternate pathologies when offering non-operative management.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 1","pages":"Article 162543"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855622","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.2025.162544
Emily M. Scire, Alex L. Huang, Thais Boccia, Kamila Moskowitzova, Ina Kycia, Tanya T. Dang, Melody Tai, Eva Zacharakis, Ayaka Aihara, Beatriz S. Bechara, David Zurakowski, Dario O. Fauza
Purpose
We sought to examine the humoral and cellular immune responses to transamniotic fetal mRNA vaccination against a human cytomegalovirus (hCMV) antigen over time in early postnatal life in a rodent model.
Methods
Seven pregnant Sprague Dawley dams underwent volume-matched intra-amniotic injections in all their fetuses (n = 82) of a custom-made mRNA encoding for hCMV envelope glycoprotein-B (hCMV-gB) antigen encapsulated by a lipid-polymer composite on gestational day 17 (E17; term = E21-22). At three time points between 1 and 3 months after birth, serum levels of antigen-specific hCMV-gB IgG antibodies were measured by ELISA. In addition, host spleen lymphocytes were incubated with or without challenge with the hCMV-gB antigen, followed by flow cytometry of culture supernatants to assess T-cell response.
Results
Overall neonatal survival was 44 % (36/82), with no significant differences between the groups. Antigen-specific hCMV-gB antibodies were present in the serum at all time points, albeit decreasing significantly from 1 to 3 months postnatally (p = 0.029). Spleen lymphocytes from vaccinated pups showed significantly increased production of IFN-γ, IL-2, TNF-α, GM-CSF, and IL-6 following antigen-specific challenge (p = 0.021 to <0.001 vs. non-challenged cells). Cellular response increased significantly over time (p = 0.043 to <0.001), indicating a maturing Th1 response.
Conclusions
Transamniotic fetal mRNA delivery of a human cytomegalovirus antigen can induce a lasting adaptive cell-mediated immune response, while also exhibiting continued antigen-specific immunoglobulin production extending into the early neonatal period in a healthy rat model. Fetal mRNA vaccination via the minimally invasive transamniotic route may become a practical strategy for the prevention of perinatal infections.
Level of evidence
N/A.
Type of study
Animal and laboratory study.
目的：在啮齿动物模型中，我们试图研究在出生后早期，经羊膜胎儿mRNA疫苗接种对人巨细胞病毒（hCMV）抗原的体液和细胞免疫反应。方法：在妊娠第17天（E17），对7只怀孕的Sprague Dawley母母（n=82）胎儿进行羊膜内等量注射，注射一种定制的mRNA，该mRNA编码hCMV包膜糖蛋白- b （hCMV- gb）抗原，该抗原被脂质-聚合物复合物包裹。词= E21-22)。在出生后1 ~ 3个月的3个时间点，采用ELISA法检测血清抗原特异性hCMV-gB IgG抗体水平。此外，用hCMV-gB抗原孵育或不孵育宿主脾淋巴细胞，然后用流式细胞术检测培养上清，以评估t细胞反应。结果：新生儿总生存率为44%(36/82)，两组间无显著差异。抗原特异性hCMV-gB抗体在所有时间点均存在于血清中，尽管在出生后1至3个月显著下降（p=0.029）。免疫幼鼠的脾脏淋巴细胞在抗原特异性攻击后显著增加IFN-γ、IL-2、TNF-α、GM-CSF和IL-6的产生（p=0.021）。结论：在健康大鼠模型中，经羊膜胎儿mRNA递送人巨细胞病毒抗原可以诱导持久的适应性细胞介导的免疫应答，同时也表现出持续的抗原特异性免疫球蛋白的产生，并延伸至新生儿早期。通过微创羊膜途径接种胎儿mRNA可能成为预防围产期感染的实用策略。证据水平：无（动物和实验室研究）研究类型：动物和实验室研究。
{"title":"Sustained early postnatal humoral and cellular immunity against human cytomegalovirus after transamniotic fetal mRNA vaccination in a rodent model","authors":"Emily M. Scire, Alex L. Huang, Thais Boccia, Kamila Moskowitzova, Ina Kycia, Tanya T. Dang, Melody Tai, Eva Zacharakis, Ayaka Aihara, Beatriz S. Bechara, David Zurakowski, Dario O. Fauza","doi":"10.1016/j.jpedsurg.2025.162544","DOIUrl":"10.1016/j.jpedsurg.2025.162544","url":null,"abstract":"<div><h3>Purpose</h3><div>We sought to examine the humoral and cellular immune responses to transamniotic fetal mRNA vaccination against a human cytomegalovirus (hCMV) antigen over time in early postnatal life in a rodent model.</div></div><div><h3>Methods</h3><div>Seven pregnant Sprague Dawley dams underwent volume-matched intra-amniotic injections in all their fetuses (n = 82) of a custom-made mRNA encoding for hCMV envelope glycoprotein-B (hCMV-gB) antigen encapsulated by a lipid-polymer composite on gestational day 17 (E17; term = E21-22). At three time points between 1 and 3 months after birth, serum levels of antigen-specific hCMV-gB IgG antibodies were measured by ELISA. In addition, host spleen lymphocytes were incubated with or without challenge with the hCMV-gB antigen, followed by flow cytometry of culture supernatants to assess T-cell response.</div></div><div><h3>Results</h3><div>Overall neonatal survival was 44 % (36/82), with no significant differences between the groups. Antigen-specific hCMV-gB antibodies were present in the serum at all time points, albeit decreasing significantly from 1 to 3 months postnatally (p = 0.029). Spleen lymphocytes from vaccinated pups showed significantly increased production of IFN-γ, IL-2, TNF-α, GM-CSF, and IL-6 following antigen-specific challenge (p = 0.021 to <0.001 vs. non-challenged cells). Cellular response increased significantly over time (p = 0.043 to <0.001), indicating a maturing Th1 response.</div></div><div><h3>Conclusions</h3><div>Transamniotic fetal mRNA delivery of a human cytomegalovirus antigen can induce a lasting adaptive cell-mediated immune response, while also exhibiting continued antigen-specific immunoglobulin production extending into the early neonatal period in a healthy rat model. Fetal mRNA vaccination via the minimally invasive transamniotic route may become a practical strategy for the prevention of perinatal infections.</div></div><div><h3>Level of evidence</h3><div>N/A.</div></div><div><h3>Type of study</h3><div>Animal and laboratory study.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 1","pages":"Article 162544"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855623","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.2025.162593
Elizabeth Reynolds, Jonathan E. Kohler, Minna M. Wieck
Purpose
Parents need to plan for patients’ recovery after pediatric operations. Standard guidance for pain medication use and time off school is not evidence based, for lack of data. This study aims to quantify recovery time and pain medication usage after common pediatric operations to improve the post-operative experience for families.
Methods
We performed a single-center retrospective survey at an academic tertiary care center. By protocol, patients who are discharged after routine outpatient surgeries are called 2–4 weeks later for follow up. We modified the post-operative call template to include asking when the patient returned to school and baseline behavior, when parent(s) returned to work, and how many days patients required pain medications. We abstracted encounters from December 2022–August 2024.
Results
Follow-up data from the postoperative phone call was available for 192 patients who underwent laparoscopic appendectomy (uncomplicated appendicitis) (n = 65), umbilical hernia repair (n = 41), laparoscopic inguinal hernia repair (n = 40), out-patient laparoscopic cholecystectomy (n = 14), miscellaneous laparoscopy (n = 5), miscellaneous skin and soft tissue cases (n = 22), and pilonidal cyst excision (n = 5). On average patients used non-narcotic pain medications for 2–3 days, but parents did not think they were at baseline until post-operative day (POD) 5–6 and patients did not return to school until POD 6–8. On average, parents returned to work on POD 1–2.
Conclusion
Children miss a predictable number of school days after common pediatric surgeries, which may be more than pediatric surgeons anticipate. Data driven pre-operative counseling can improve families’ trust in their health care team and facilitate anticipation of discharge needs.
{"title":"Quantifying recovery time after common pediatric surgical procedures","authors":"Elizabeth Reynolds, Jonathan E. Kohler, Minna M. Wieck","doi":"10.1016/j.jpedsurg.2025.162593","DOIUrl":"10.1016/j.jpedsurg.2025.162593","url":null,"abstract":"<div><h3>Purpose</h3><div>Parents need to plan for patients’ recovery after pediatric operations. Standard guidance for pain medication use and time off school is not evidence based, for lack of data. This study aims to quantify recovery time and pain medication usage after common pediatric operations to improve the post-operative experience for families.</div></div><div><h3>Methods</h3><div>We performed a single-center retrospective survey at an academic tertiary care center. By protocol, patients who are discharged after routine outpatient surgeries are called 2–4 weeks later for follow up. We modified the post-operative call template to include asking when the patient returned to school and baseline behavior, when parent(s) returned to work, and how many days patients required pain medications. We abstracted encounters from December 2022–August 2024.</div></div><div><h3>Results</h3><div>Follow-up data from the postoperative phone call was available for 192 patients who underwent laparoscopic appendectomy (uncomplicated appendicitis) (n = 65), umbilical hernia repair (n = 41), laparoscopic inguinal hernia repair (n = 40), out-patient laparoscopic cholecystectomy (n = 14), miscellaneous laparoscopy (n = 5), miscellaneous skin and soft tissue cases (n = 22), and pilonidal cyst excision (n = 5). On average patients used non-narcotic pain medications for 2–3 days, but parents did not think they were at baseline until post-operative day (POD) 5–6 and patients did not return to school until POD 6–8. On average, parents returned to work on POD 1–2.</div></div><div><h3>Conclusion</h3><div>Children miss a predictable number of school days after common pediatric surgeries, which may be more than pediatric surgeons anticipate. Data driven pre-operative counseling can improve families’ trust in their health care team and facilitate anticipation of discharge needs.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 1","pages":"Article 162593"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958347","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.2025.162533
Julia Ferreira, Boaz Laor, Elena Guadagno, Sherif Emil
Background
Despite the transformative influence of social media on connectivity, learning, and networking, its role and impact on surgical education remains undefined. In the current study, we evaluated the impact of #CBCLIPS (Case Based Clinical Learning In Pediatric Surgery), a social media-based pediatric surgery educational program.
Methods
A descriptive mixed-methods study evaluated the impact of #CBCLIPS, by analyzing social media engagement metrics (likes, shares, comments) across X, Facebook, and LinkedIn. Additionally, an online survey administered on these platforms assessed participants' perceptions of knowledge gained and satisfaction with the program. Descriptive statistics summarized quantitative data, while thematic analysis was applied to qualitative feedback.
Results
#CBCLIPS was highly relevant and appealing to its viewers in all three social media platforms. On X, the episodes boasted an average engagement rate of 6.9 %, significantly outperforming typical benchmarks for the platform. Visibility for #CBCLIPS was substantial on both X and LinkedIn, achieving up to 13,810 and 8282 impressions, respectively. Facebook emerged as the leading platform for interactive engagement, with medians of 60 likes and 13 comments per post, reinforcing its position as the premier platform for fostering community discussions. The survey was completely answered by 160 people from 71 different countries.
Conclusion
#CBCLIPS is a continuous interactive educational program that significantly engages an international audience, facilitates knowledge acquisition and application, and garners high support among participants. Its reach and success demonstrate the effectiveness of social media-based education in pediatric surgery.
{"title":"#CBCLIPS: The international impact of a social media-based pediatric surgery interactive educational program","authors":"Julia Ferreira, Boaz Laor, Elena Guadagno, Sherif Emil","doi":"10.1016/j.jpedsurg.2025.162533","DOIUrl":"10.1016/j.jpedsurg.2025.162533","url":null,"abstract":"<div><h3>Background</h3><div>Despite the transformative influence of social media on connectivity, learning, and networking, its role and impact on surgical education remains undefined. In the current study, we evaluated the impact of #CBCLIPS (Case Based Clinical Learning In Pediatric Surgery), a social media-based pediatric surgery educational program.</div></div><div><h3>Methods</h3><div>A descriptive mixed-methods study evaluated the impact of #CBCLIPS, by analyzing social media engagement metrics (likes, shares, comments) across X, Facebook, and LinkedIn. Additionally, an online survey administered on these platforms assessed participants' perceptions of knowledge gained and satisfaction with the program. Descriptive statistics summarized quantitative data, while thematic analysis was applied to qualitative feedback.</div></div><div><h3>Results</h3><div>#CBCLIPS was highly relevant and appealing to its viewers in all three social media platforms. On X, the episodes boasted an average engagement rate of 6.9 %, significantly outperforming typical benchmarks for the platform. Visibility for #CBCLIPS was substantial on both X and LinkedIn, achieving up to 13,810 and 8282 impressions, respectively. Facebook emerged as the leading platform for interactive engagement, with medians of 60 likes and 13 comments per post, reinforcing its position as the premier platform for fostering community discussions. The survey was completely answered by 160 people from 71 different countries.</div></div><div><h3>Conclusion</h3><div>#CBCLIPS is a continuous interactive educational program that significantly engages an international audience, facilitates knowledge acquisition and application, and garners high support among participants. Its reach and success demonstrate the effectiveness of social media-based education in pediatric surgery.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 1","pages":"Article 162533"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958229","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.2025.162516
Alex L. Huang, Emily M. Scire, Tanya T. Dang, Melody Tai, Eva Zacharakis, Blen Yohannes, Ina Kycia, David Zurakowski, Dario O. Fauza
Purpose
Modified monoclonal class-G immunoglobulins (IgG) have been shown to protect infants from Respiratory Syncytial Virus (RSV), a prevalent disease with particularly high morbidity in newborns. We sought to determine whether a clinically relevant monoclonal IgG against RSV could be delivered to the fetus via transammiotic fetal immunotherapy (TRAFIT) and remain bioavailable after birth.
Methods
Fetuses (n = 75) from five pregnant dams received volume-matched intra-amniotic injections on gestational day 17–18 (E17-18, term = E21-22) of either an FDA approved and commercially available recombinant human immunoglobulin-G1-kappa (IgG1κ) monoclonal antibody against RSV (Nirsevimab®) (n = 30) or of saline (n = 45), the latter to control for possible IgG1κ interspecies homology. Levels of IgG1κ were quantified by ELISA in the serum and lungs at term and on postnatal day of life 7 (P7). Maternal serum samples were also tested. Statistical analyses included two-tailed Fisher's exact test, Wilcoxon rank sum test, and mixed-effects median regression (p < 0.05).
Results
Overall survival was not significantly different between the two groups (p = 0.808). Levels of the IgG1κ monoclonal antibody were significantly higher than that of controls in serum and lung samples at both term and P7 (all p < 0.001). IgG1k levels in maternal serum samples were not significantly different between the groups.
Conclusions
TRAFIT with a clinically relevant recombinant human monoclonal antibody against RSV leads to sustained levels of the antibody in the serum and lungs of the neonate at term and into the early neonatal period in a rat model. TRAFIT could become a viable option for the prevention against RSV in newborns.
{"title":"Transamniotic fetal delivery of recombinant human immunoglobulin monoclonal antibodies: A potential novel strategy for prevention of neonatal Respiratory Syncytial Virus (RSV) disease","authors":"Alex L. Huang, Emily M. Scire, Tanya T. Dang, Melody Tai, Eva Zacharakis, Blen Yohannes, Ina Kycia, David Zurakowski, Dario O. Fauza","doi":"10.1016/j.jpedsurg.2025.162516","DOIUrl":"10.1016/j.jpedsurg.2025.162516","url":null,"abstract":"<div><h3>Purpose</h3><div>Modified monoclonal class-G immunoglobulins (IgG) have been shown to protect infants from Respiratory Syncytial Virus (RSV), a prevalent disease with particularly high morbidity in newborns. We sought to determine whether a clinically relevant monoclonal IgG against RSV could be delivered to the fetus via transammiotic fetal immunotherapy (TRAFIT) and remain bioavailable after birth.</div></div><div><h3>Methods</h3><div>Fetuses (n = 75) from five pregnant dams received volume-matched intra-amniotic injections on gestational day 17–18 (E17-18, term = E21-22) of either an FDA approved and commercially available recombinant human immunoglobulin-G1-kappa (IgG1κ) monoclonal antibody against RSV (Nirsevimab®) (n = 30) or of saline (n = 45), the latter to control for possible IgG1κ interspecies homology. Levels of IgG1κ were quantified by ELISA in the serum and lungs at term and on postnatal day of life 7 (P7). Maternal serum samples were also tested. Statistical analyses included two-tailed Fisher's exact test, Wilcoxon rank sum test, and mixed-effects median regression (p < 0.05).</div></div><div><h3>Results</h3><div>Overall survival was not significantly different between the two groups (p = 0.808). Levels of the IgG1κ monoclonal antibody were significantly higher than that of controls in serum and lung samples at both term and P7 (all p < 0.001). IgG1k levels in maternal serum samples were not significantly different between the groups.</div></div><div><h3>Conclusions</h3><div>TRAFIT with a clinically relevant recombinant human monoclonal antibody against RSV leads to sustained levels of the antibody in the serum and lungs of the neonate at term and into the early neonatal period in a rat model. TRAFIT could become a viable option for the prevention against RSV in newborns.</div></div><div><h3>Level of evidence</h3><div>N/A (animal and laboratory study).</div></div><div><h3>Type of study</h3><div>animal and laboratory study.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 1","pages":"Article 162516"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817012","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.2025.162540
Alexandra Dimmer , Zanib Nafees , Sabrina Beauseigle , Franco A. Carnevale , Elena Guadagno , Dan Poenaru , Pramod Puligandla
Background
Patient and family perspectives on CDH are infrequently explored, impairing clinicians’ understanding of illness impact on functioning and desired support. We investigated the lived experiences of CDH patients and primary caregivers, including those with neurodevelopmental impairment (NDI), regarding the adequacy of clinical and community support.
Methods
Cross-sectional qualitative study convening focus groups (FGs) to explore CDH patient experiences within our CDH follow-up clinic. Participants >4 years were recruited between December 2023–March 2024. FGs were grouped by language preference, presence of NDI, and clinic graduate status. Virtual FG sessions were assessed using inductive thematic analyses.
Results
Twenty-six participants (10 CDH children/12 caregivers/4 clinic graduates) participated among 4 FGs. Thematic analysis revealed 4 themes: experiencing CDH as a caregiver; experiencing CDH as a child; striving for normalcy; and getting the support we need. Caregivers reported shock at CDH diagnosis and during initial hospitalization. Caregiver isolation/distress were common, particularly when physically separated from their newborn. Memories faded with time with parents revealing few long-term effects on their children. While most reported minimal impact, some CDH patients struggled with visible CDH indicators (e.g. scars). Patients expressed a high quality of life despite NDI or co-morbidities. Caregivers were satisfied with clinical support and easy contact but desired interaction with other CDH families for emotional/psychological support.
Conclusion
This first study on CDH lived experiences revealed high quality of life, despite early challenges. Caregivers valued the CDH clinic for easy access to expert care but desired contact with other CDH families for emotional support.
Level of Evidence
Level II (prospectively collected data, retrospective analysis).
{"title":"Untold stories: A qualitative investigation of patient and family experiences with congenital diaphragmatic hernia","authors":"Alexandra Dimmer , Zanib Nafees , Sabrina Beauseigle , Franco A. Carnevale , Elena Guadagno , Dan Poenaru , Pramod Puligandla","doi":"10.1016/j.jpedsurg.2025.162540","DOIUrl":"10.1016/j.jpedsurg.2025.162540","url":null,"abstract":"<div><h3>Background</h3><div>Patient and family perspectives on CDH are infrequently explored, impairing clinicians’ understanding of illness impact on functioning and desired support. We investigated the lived experiences of CDH patients and primary caregivers, including those with neurodevelopmental impairment (NDI), regarding the adequacy of clinical and community support.</div></div><div><h3>Methods</h3><div>Cross-sectional qualitative study convening focus groups (FGs) to explore CDH patient experiences within our CDH follow-up clinic. Participants >4 years were recruited between December 2023–March 2024. FGs were grouped by language preference, presence of NDI, and clinic graduate status. Virtual FG sessions were assessed using inductive thematic analyses.</div></div><div><h3>Results</h3><div>Twenty-six participants (10 CDH children/12 caregivers/4 clinic graduates) participated among 4 FGs. Thematic analysis revealed 4 themes: experiencing CDH as a caregiver; experiencing CDH as a child; striving for normalcy; and getting the support we need. Caregivers reported shock at CDH diagnosis and during initial hospitalization. Caregiver isolation/distress were common, particularly when physically separated from their newborn. Memories faded with time with parents revealing few long-term effects on their children. While most reported minimal impact, some CDH patients struggled with visible CDH indicators (e.g. scars). Patients expressed a high quality of life despite NDI or co-morbidities. Caregivers were satisfied with clinical support and easy contact but desired interaction with other CDH families for emotional/psychological support.</div></div><div><h3>Conclusion</h3><div>This first study on CDH lived experiences revealed high quality of life, despite early challenges. Caregivers valued the CDH clinic for easy access to expert care but desired contact with other CDH families for emotional support.</div></div><div><h3>Level of Evidence</h3><div>Level II (prospectively collected data, retrospective analysis).</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 1","pages":"Article 162540"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847127","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.2025.162539
R Scott Eldredge , Brielle Ochoa , Kathleen Heller , Katie W. Russell , Zachary J. Moore , Stephanie D. Chao , Akanksha Sabapaty , Jose Diaz-Miron , Nell T. Weber , Kristin Rassam , Emily Khoury , Chakshu Soni , Romeo C. Ignacio , Benjamin E. Padilla
Introduction
Intercostal nerve cryoablation (INC) during the minimally invasive repair of pectus excavatum (MIRPE) provides effective post-operative analgesia; long-term neurosensory effects of MIRPE/INC remain unclear. The study aimed to compare chest wall sensation at pectus-bar removal in patients who previously had MIRPE with and without INC.
Methods
We conducted a multi-institutional prospective study of patients ≤21 who underwent MIRPE with and without INC between 1/11/2021-8/18/2024. Chest wall sensory testing was performed pre-bar removal, and at 2 weeks and 2 months post-bar removal. Demographics and operative details of MIRPE were reviewed. Chest wall hypoesthesia to stimulation were compared between groups.
Results
166 participants were enrolled (male - 86 %, mean age - 18.3 ± 1.7 years at bar removal, median duration of bar implantation - 3.0 [IQR:2.9–3.1] years) INC was performed in 78 % (n = 130) during MIRPE. Compared to no-INC, INC patients were more likely to have >1 pectus bar (82 % vs 47 %, p < 0.001) and pericostal suture fixation (85 % vs 44 %, p = 0.004). Prior to bar removal, chest wall hypoesthesia in ≥1 dermatome was found in 58 % of INC vs 50 % of no-INC (p = 0.451). At two month follow up 85 % of patients had normal chest wall sensation (85 % INC vs 95 % no-INC, p = 0.460). Hypoesthesia was associated with >1 pectus bar implanted.
Conclusion
Three years following MIRPE, hypoesthesia to 1–2 dermatomes in the region of the pectus bar(s) is present in nearly half of patients and is not associated with intercostal nerve cryoablation. Following bar removal, chest wall sensation is normal in approximately 80 % of all patients.
介绍：肋间神经冷冻消融术（INC）微创修复漏斗胸（MIRPE）提供了有效的术后镇痛；MIRPE/INC的长期神经感觉效应尚不清楚。该研究旨在比较先前MIRPE合并和不合并INC的患者胸壁感觉。方法：我们在2021年11月1日至2024年8月18日期间对≤21岁的患者进行了MIRPE合并和不合并INC的多机构前瞻性研究。取棒前、取棒后2周和2个月分别进行胸壁感觉测试。回顾了MIRPE的人口统计和操作细节。比较两组胸壁对刺激的感觉减退。结果：共纳入166名参与者（86%为男性，拔棒时平均年龄为18.3±1.7岁，植入棒的中位持续时间为3.0年[IQR:2.9-3.1]年），其中78% （n=130）在MIRPE期间进行了INC。与未植入胸棒的患者相比，植入胸棒的患者更有可能植入1个胸棒（82% vs 47%）。结论：MIRPE术后3年，近一半的患者出现胸大肌区1-2个皮节的感觉减退，且与肋间神经冷冻消融无关。除棒后，约80%的患者胸壁感觉正常。
{"title":"Feeling the difference: Long-term sensory outcomes following the minimally invasive repair of pectus excavatum with and without intercostal nerve cryoablation: A multicenter prospective observation study","authors":"R Scott Eldredge , Brielle Ochoa , Kathleen Heller , Katie W. Russell , Zachary J. Moore , Stephanie D. Chao , Akanksha Sabapaty , Jose Diaz-Miron , Nell T. Weber , Kristin Rassam , Emily Khoury , Chakshu Soni , Romeo C. Ignacio , Benjamin E. Padilla","doi":"10.1016/j.jpedsurg.2025.162539","DOIUrl":"10.1016/j.jpedsurg.2025.162539","url":null,"abstract":"<div><h3>Introduction</h3><div>Intercostal nerve cryoablation (INC) during the minimally invasive repair of pectus excavatum (MIRPE) provides effective post-operative analgesia; long-term neurosensory effects of MIRPE/INC remain unclear. The study aimed to compare chest wall sensation at pectus-bar removal in patients who previously had MIRPE with and without INC.</div></div><div><h3>Methods</h3><div>We conducted a multi-institutional prospective study of patients ≤21 who underwent MIRPE with and without INC between 1/11/2021-8/18/2024. Chest wall sensory testing was performed pre-bar removal, and at 2 weeks and 2 months post-bar removal. Demographics and operative details of MIRPE were reviewed. Chest wall hypoesthesia to stimulation were compared between groups.</div></div><div><h3>Results</h3><div>166 participants were enrolled (male - 86 %, mean age - 18.3 ± 1.7 years at bar removal, median duration of bar implantation - 3.0 [IQR:2.9–3.1] years) INC was performed in 78 % (n = 130) during MIRPE. Compared to no-INC, INC patients were more likely to have >1 pectus bar (82 % vs 47 %, p < 0.001) and pericostal suture fixation (85 % vs 44 %, p = 0.004). Prior to bar removal, chest wall hypoesthesia in ≥1 dermatome was found in 58 % of INC vs 50 % of no-INC (p = 0.451). At two month follow up 85 % of patients had normal chest wall sensation (85 % INC vs 95 % no-INC, p = 0.460). Hypoesthesia was associated with >1 pectus bar implanted.</div></div><div><h3>Conclusion</h3><div>Three years following MIRPE, hypoesthesia to 1–2 dermatomes in the region of the pectus bar(s) is present in nearly half of patients and is not associated with intercostal nerve cryoablation. Following bar removal, chest wall sensation is normal in approximately 80 % of all patients.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 1","pages":"Article 162539"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847108","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.2025.162523
Olivia L. Katz , Jeanne Wu , Brian A. Coakley
Purpose
In the United States, physician compensation for surgical procedures is largely based on Current Procedural Terminology (CPT)-specific work Relative Value Units (wRVUs), which are meant to reflect operative time, technical skill and effort, mental effort and judgement, and stress. We sought to determine if operative time and case complexity are appropriately compensated for in pediatric surgical procedures.
Methods
The ACS Pediatric NSQIP database was surveyed for procedures that individually accounted for at least 0.1 % of the database in the year 2022. The median operative time and complication rates for these procedures from 2018 to 2022 were calculated. Major complications were defined as those causing significant deviation from the typical clinical course for the index procedure, as determined by the authors. Complications defined as minor were those that were judged to have little effect on a patient's expected clinical course or outcome. These were utilized as a surrogate for case complexity. 2022 wRVU and median operative time were used to calculate wRVU per hour of operative time (wRVU/h). Linear regression analysis was utilized to investigate the relationship between operative time and wRVU, operative time and wRVU/h, and complication rate and wRVU/h.
Results
Linear regression analysis demonstrated a moderate positive association between median operative time and wRVU (R2 = 0.2259, p < 0.0001). For every additional hour of operative time, however, there was an associated decrease in wRVU/h by 2.01 (or 0.33 for every 10 min, R2 = 0.05568, p = 0.0012). Both major and minor complications are both associated with wRVU but neither are significantly associated with wRVU/h.
Conclusions
Compensation is positively correlated with operative time for pediatric surgical procedures. However, the current wRVU system significantly favors shorter procedures. Case complexity is only weakly correlated with wRVU/h, and below the threshold of statistical significance, which suggests that the wRVU system may not adequately compensate pediatric surgeons for performing lengthy and complex procedures.
目的：在美国，外科手术的医生报酬主要基于当前手术术语（Current procedure Terminology， CPT）-specific work Relative Value Units (wRVUs)，它旨在反映手术时间、技术技能和努力、精神努力和判断以及压力。我们试图确定手术时间和病例复杂性是否在儿科外科手术中得到适当补偿。方法：对ACS儿科NSQIP数据库进行调查，寻找在2022年单独占数据库至少0.1%的手术。计算2018-2022年这些手术的中位手术时间和并发症发生率。主要并发症被定义为那些引起明显偏离典型临床过程的指标程序，由作者确定。轻微并发症是指那些被认为对患者预期的临床过程或结果影响不大的并发症。它们被用作案例复杂性的替代。采用2022年wRVU和中位手术时间计算每小时手术时间的wRVU （wRVU/h）。采用线性回归分析探讨手术时间与wRVU、手术时间与wRVU/h、并发症发生率与wRVU/h的关系。结果：线性回归分析显示中位手术时间与wRVU呈正相关（R2 = 0.2259, p < 0.0001）。然而，每增加1小时的手术时间，wRVU/h相关下降2.01（或每10分钟0.33,R2 = 0.05568, p = 0.0012）。主要和次要并发症均与wRVU相关，但均与wRVU/h无关。结论：小儿外科手术补偿与手术时间呈正相关。然而，目前的wRVU系统明显倾向于缩短程序。病例复杂性与wRVU/h仅呈弱相关，且低于统计显著性阈值，这表明wRVU系统可能无法充分补偿儿科外科医生进行的冗长而复杂的手术。
{"title":"Work relative value units and the association with operative time and surgical complexity: A pediatric NSQIP analysis","authors":"Olivia L. Katz , Jeanne Wu , Brian A. Coakley","doi":"10.1016/j.jpedsurg.2025.162523","DOIUrl":"10.1016/j.jpedsurg.2025.162523","url":null,"abstract":"<div><h3>Purpose</h3><div>In the United States, physician compensation for surgical procedures is largely based on Current Procedural Terminology (CPT)-specific work Relative Value Units (wRVUs), which are meant to reflect operative time, technical skill and effort, mental effort and judgement, and stress. We sought to determine if operative time and case complexity are appropriately compensated for in pediatric surgical procedures.</div></div><div><h3>Methods</h3><div>The ACS Pediatric NSQIP database was surveyed for procedures that individually accounted for at least 0.1 % of the database in the year 2022. The median operative time and complication rates for these procedures from 2018 to 2022 were calculated. Major complications were defined as those causing significant deviation from the typical clinical course for the index procedure, as determined by the authors. Complications defined as minor were those that were judged to have little effect on a patient's expected clinical course or outcome. These were utilized as a surrogate for case complexity. 2022 wRVU and median operative time were used to calculate wRVU per hour of operative time (wRVU/h). Linear regression analysis was utilized to investigate the relationship between operative time and wRVU, operative time and wRVU/h, and complication rate and wRVU/h.</div></div><div><h3>Results</h3><div>Linear regression analysis demonstrated a moderate positive association between median operative time and wRVU (R<sup>2</sup> = 0.2259, p < 0.0001). For every additional hour of operative time, however, there was an associated decrease in wRVU/h by 2.01 (or 0.33 for every 10 min, R<sup>2</sup> = 0.05568, p = 0.0012). Both major and minor complications are both associated with wRVU but neither are significantly associated with wRVU/h.</div></div><div><h3>Conclusions</h3><div>Compensation is positively correlated with operative time for pediatric surgical procedures. However, the current wRVU system significantly favors shorter procedures. Case complexity is only weakly correlated with wRVU/h, and below the threshold of statistical significance, which suggests that the wRVU system may not adequately compensate pediatric surgeons for performing lengthy and complex procedures.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 1","pages":"Article 162523"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859289","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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