Quick Literature Updates Episode 5

Hello pediatric surgery family. I'm M Tombash, a research fellow from Cincinnati Children's Hospital Medical Center. And along with Stay Current, we are sharing knowledge to improve child health around the globe. Today, our team is going to deliver the articles that you should know about. We have four papers today. First three of them are from the Journal of Pediatric Surgery. And the last one is from the Journal of Trauma and Acute Care Surgery. We don't have much time, so let's start. Our first paper, titled as Cryoablation is associated with shorter length of stay and reduced opioid use after Ravitch procedure by Radick at all. And this paper summarized by Ellen and Cisco. She's a research fellow at Cincinnati Children's Hospital. In this study, the authors did a retrospective review of patients who underwent the modified Ravitch procedure for repair of either pectus excavatum or pectus carinatum. And they compared patients who had an intercostal nerve cryoablation for pain control to those who had a thoracic epidural. So here are their findings. They found that the patients with the intercostal nerve cryoablation had a shorter hospital length of stay than those patients who had a thoracic epidural. They also found that intercostal nerve cryoablation was associated with a longer surgical time and increased total OR time. But it was also associated with decreased total hospital costs. Awesome! Let's keep moving. Our second paper is Major Stoma Related Morbidity in Young Children Following Stoma Formation and Closure, a retrospective cohort study by Vogel at all. This one is summarized by Dr. Todd Ponsky. He's a pediatric surgeon at Cincinnati Children's Hospital. Okay, so over the past 5 or 10 years or so, there's kind of been this trend, this push towards doing a primary anastomosis after bowel section as opposed to a stoma. But are you the type of conservative surgeon that generally believes that a stoma is the safer course of action? Well, if so, this is an article you may want to know about. Group out of Amsterdam did a 20-year retrospective review of patients that had stomass to assess the true morbidity. They found that about 40% of patients had some sort of major morbidity from a stoma, whether in the creation or the takedown of the stoma. For example, about 25% of patients that have a stoma creation will have either a high output stoma or they'll have a prolapse, and about 25% of patients in the stoma takedown will have a stricture, a leak, or a hernia at the stoma site. So, these are pretty big numbers. What's the conclusion? Think twice that thinking that a stoma is a gimme. It's not. Next, we have our third paper of the day. Massive transfusion in pediatric trauma, does more blood predict mortality by Ripucci at all. And this paper summarized by Brittany Levy. She's a research fellow at Cincinnati Children's Hospital as well. So, this study posed a question: does the amount of blood transfusion that you give within the first 24 hours of trauma in kids that are getting massive transfusion protocol predict their mortality? So, they looked at 633 kids. 58 died within the first 24 hours, 78 died after 24 hours, but 575 survived. So, here's the big question, was there a difference? And no, they found no statistically significant difference in blood transfusion requirements in any of those three groups, implying that the amount of blood you need isn't linked to patient outcomes and there's no amount of blood transfusion that's futile in pediatric trauma. Here we are. The last paper of the day is from the Journal of Trauma and Acute Care Surgery. Urine leaks in children sustaining blunt renal trauma by Abdul Ghani at all. This paper summarized by Sicily Hijina. She's also a research fellow at Cincinnati Children's Hospital. This was a retrospective review of a single institutions between 2005 and 2020. They analyzed 347 patients under 19 years old with renal blunt trauma. Of them, 44 had urinary leak. They found that for trauma patients, the mean age is 16, but for urinary leaks is 13. The most frequent symptoms arrival are hematuria and fever. The injury patterns associated with leak were isolated renal trauma, lesion in the upper lateral quadrant, and a grade three or higher injury. Check the link in the description below to read each paper. We hope you like this episode. Please follow us on social media, give us a rating and subscribe to our YouTube channel. And don't forget to download our Stay Current app on App Store or Play Store for more content. Thank you for listening. Cincinnati Children's Hospital and Stay Current are sharing knowledge to improve child health around the globe.