The Incidence and Causes of Unplanned Reoperations as a Quality Indicator in Pediatric Surgery

Background: Unplanned return to the operating room (uROR) within the 30-day postoperative period can be used as a quality indicator in pediatric surgery. The aim of this study was to investigate and evaluate uROR as a quality indicator. Methods: The case records of pediatric patients who underwent reoperation within the 30-day period after primary surgery, from 1 January 2018 to 31 December 2020 were retrospectively reviewed. The primary outcome of the study was the rate of uROR as a quality indicator in pediatric surgery. Secondary outcomes were indications for primary and secondary surgery, types and management of complications, factors that led to uROR, length of hospital stay, duration of surgery and anesthesia, and starting time of surgery. Results: A total of 3982 surgical procedures, under general anesthesia, were performed during the three-year study period (2018, n = 1432; 2019, n = 1435; 2020, n = 1115). Elective and emergency surgeries were performed in 3032 (76.1%) and 950 (23.9%) patients, respectively. During the study period 19 (0.5%) pediatric patients, with the median age of 11 years (IQR 3, 16), underwent uROR within the 30-day postoperative period. The uROR incidence was 6 (0.4%), 6 (0.4%), and 7 (0.6%) for years 2018, 2019, and 2020, respectively (p = 0.697). The incidence of uROR was significantly higher in males (n = 14; 73.7%) than in females (n = 5; 26.3%) (p = 0.002). The share of unplanned reoperations in studied period was 4.5 times higher in primarily emergency surgeries compared to primarily elective surgeries (p < 0.001). The difference in incidence was 0.9% (95% CI, 0.4–1.4). Out of children that underwent uROR within the 30-day period after elective procedures, 50% had American Society of Anesthesiologists (ASA) score three or higher (p = 0.016). The most common procedure which led to uROR was appendectomy (n = 5, 26.3%) while the errors in surgical technique were the most common cause for uROR (n = 11, 57.9%). Conclusion: Unplanned reoperations within the 30-day period after the initial surgical procedure can be a good quality indicator in pediatric surgery. Risk factors associated with uROR are emergency surgery, male gender, and ASA score ≥3 in elective pediatric surgery.

Meckel’s Diverticulum in Children: A Monocentric Experience and Mini-Review of Literature

Vitelline duct anomalies (VDA, including Meckel’s diverticulum (MD)) result from failed embryologic obliteration. This study aimed for characteristics in symptomatic versus asymptomatic VDA, analyzing clinico-laboratory data from 73 children, aged 1 day to 17 years, treated at a tertiary Pediatric Surgery Institution from 2002–2017. A male preponderance was obtained (ratio 3.6:1). MD accounted for 85% of VDA. Incidence of symptomatic VDA decreased with older age. Leading symptoms were intestinal obstruction and hemorrhage. Mucosal heterotopia (present in 39% of symptomatic MD) was associated with anemia and lowered CRP-levels. On ROC-analysis, hemoglobin < 8.6 g/dL, CRP < 0.6 mg/dL and MD distance to ileocecal valve >40 cm were predictors of ectopic tissue in symptomatic MD. Our data confirmed known characteristics as male preponderance, declined incidence of symptomatic cases with age and predominance of gastric ectopia in symptomatic MD. Moreover, anemia and prolonged distance of MD to ileocecal valve were predictors of ectopic mucosa in symptomatic MD.

Addressing barriers to evidence-based medicine in pediatric surgery: an introduction to the Canadian Association of Paediatric Surgeons Evidence-Based Resource

BackgroundPediatric surgical practice lags behind medicine in presence and use of evidence, primarily due to time constraints of using existing tools that are not specific to pediatric surgery, lack of sufficient patient data and unstructured pediatric surgery training methods.MethodWe developed, disseminated and tested the effectiveness of an evidence-based resource for pediatric surgeons and researchers that provides brief, informative summaries of quality-assessed systematic reviews and meta-analyses on conflicting pediatric surgery topics.ResultsResponses of 91 actively practicing surgeons who used the resource were analysed. The majority of participants found the resource useful (75%), improved their patient care (66.6%), and more than half (54.2%) found it useful in identifying research gaps. Almost all participants reported that the resource could be used as a teaching tool (93%).ConclusionLack of awareness of the resource is the primary barrier to its routine use, leading to potential calls for more active dissemination worldwide. Users of the Canadian Association of Paediatric Surgeons Evidence-Based Resource find that the summaries are useful, identify research gaps, help mitigate multiple barriers to evidence-based medicine, and may improve patient care.

Pattern of Congenital Overt and Occult Pediatric Surgical Anomalies in a Tertiary Care Centre Over 5 Years

ongenital anomalies are important cause of infant and childhood deaths, chronic illness and disability. The proportion of deaths and disability due to congenital anomalies has increased, as deaths due to other diseases have decreased over the years due to better health care. Hence it is essential to have basic epidemiological information of these anomalies. This is a hospital based, cross-sectional, record based study, conducted in the Department of Pediatric Surgery, Govt. Medical College Thiruvananthapuram, Kerala. Sample size included 300 children below the age of 12years admitted in the department of pediatric surgery with various major congenital anomalies, over a period of 5 years. More than half of these children were admitted after infancy for treatment, male children were more compared to females. Majority of these children were from low socioeconomic group. Only in 5.6% cases there was a history of consanguineous marriage. In 7.33% there was family history of congenital anomalies. In 32% cases the anomalies were detected in the antenatal period. Most of the anomalies were isolated anomalies. Genitourinary system was the most common system to be involved followed by, gastrointestinal tract. 91.67% children underwent surgical treatment, and only 10.67% children had major complications in postoperative period. This study shows that congenital anomalies are a major cause of hospital admissions in children of all ages. Pattern of anomalies seen in various centers are different. Knowledge of the pattern of congenital anomalies may be useful in planning health services. Keywords: Congenital, Anomalies, Pediatric surgery.

ASSESSMENT OF REFLECTIVE LEARNING STRATEGIES IN PEDIATRIC SURGERY COURSE AT MEDICAL UNIVERSITY

The article is aimed at studying medical students’ reflective strategies for learning the Pediatric Surgery course at medical university. We used a modified version of the Motivated Strategies for Learning questionnaire (Soemantri et al., 2018), which has four subscales: self-orientation, critical thinking, self-regulation, and feedback seeking. The self-orientation component deals with students’ perceptions on their self-efficacy and internal motivation. The participants were fourty-six 5-th year medical students from the Bogomolets National Medical University, Kyiv, Ukraine. The survey was held in May 2021 when the students finished their spring semester in the online mode. We observed the prevalence of high and moderate levels in all the variables, but the indicators of Feedback seeking are lower which can be explained by the specificities of online learning. The authors propose methodological recommendations for educators how to create an environment for reflective learning to develop students’ reflective skills and employ alternative assessment strategies in the classroom.

Ductus Omphalocele Mesenteric Persisten: A Case Reports

Background: The ductus omphalomecenterica is a normal embryological structure where it serves to connect the midgut of the fetus to the yolk sac. Usually, this ductus will disappear at 9 weeks gestation. However, if this condition does not occur, then it can cause various anomalies to appear in the fetus. Case Presentation: The patient was reported to be hospitalized with the chief complaint of choking. Echocardiography examination with the results of the examination found the presence of cyanotic congenital heart disease (CHD). The patient was referred to pediatric surgery with a diagnosis of persistent mesenteric duct omphalocele. Terminal ileum anastomoses resection laparotomy was performed. Conclusion: After surgery due to complications of pneumonia and sepsis, the patient died.