Matthew Urichuk, PhD - Best of the Best in Pediatric Surgery 2024

We're moving on to the last one of this heat. So we have Doctor Matthew Urchk from Canada with the work uh entitled Invidual, uh, Individuals with Thoracicabdominal congenital Surgical Anomalies that are at Increased Risk of Adverse mental Health Outcomes, a Longitudinal retrospective cohort Study. Let's see what this one's all about. Hi everyone, I'm Matt Yerchuk. I'm a 3rd year medical student at the University of Manitoba, and today I'm gonna be sharing new findings assessing a possible link between congenital surgical anomalies and mental health disorders including anxiety, mood disorders such as depression, and substance use disorders. We have no conflicts of interest to declare. Congenital surgical anomalies are major anomalies requiring neonatal surgical correction for survival. They require prolonged hospital stays, exposure to general anesthetic, and increased exposure to the healthcare system throughout childhood. While there is substantial research completed on early clinical course of these children, there's substantially less on their long-term mental health outcomes. Long-term outcomes, however, are often the focus of parental questioning and concerns. Questions like what will their life be like and, and will my child be happy? So during a follow-up visit, a new parent of a child with Hirschsprung disease asked whether their children was at a higher risk of having autism. Unfortunately, due to gaps in the literature, there was no answer for this concerned parent or the hundreds of other parents who may be wondering the same thing. This question has since expanded to long-term neuropsychiatric outcomes as a whole, including mental health outcomes, which we are discussing today. We collected data on every child born with a congenital surgical anomaly in Manitoba, Canada between 1991 and 2022. We linked this data to a province-wide administrative data set to identify 10 date of birth match controls for each case. From these databases, we were able to analyze every single medical diagnosis for each child made by a medical professional uh from their birth date until 2022. So in total, we analyzed 818 children born with congenital surgical anomalies shown in the slide, and nearly 8200 controls. Here, we're looking at a table that will show the hazard ratios controlling for the child's sex and their socioeconomic status. Values above one indicate higher likelihood of diagnosis in children with a congenital surgical anomaly compared to controls. Statistical significance is denoted by an asterisk and will be highlighted in yellow. In the diagnoses of all mental health disorders, there's two pertinent findings. First, pooled analyses indicated a descriptive but non-significant increase in mental health disorders in individuals with congenital surgical anomalies. Second, in anomaly-specific analyses, only anorectal malformation saw an increase in risk, being about twice as likely to be diagnosed with a mental health disorder. For anxiety and mood disorders, there's no significant increase in children with congenital surgical anomalies. Only patients with anorectal malformation were found to be at an increased risk, being about twice as likely to be diagnosed with anxiety disorders, but not significantly more likely to be diagnosed with mood disorders. And finally, we have substance use disorders. Pooled analyses indicated a significant 86% increase in diagnoses of substance use disorders across all anomalies. This was largely driven by patients with anorectal malformation and esophageal atresia, who are 4 times as likely to be diagnosed with this disorder. So why was there an increase in substance use disorders, but not other mental health disorders? To be honest, we don't know and we're not able to definitively say why, but there are 3 possible hypotheses. The first is that patients are able to use coping mechanisms. The survivors of these anomalies appear to be resilient, showing no difference in most mental health disorders. The second is that the increase in substance use disorder risk indicates that a subset of this population may be using substances more frequently. A subset of patients may be self-medicating and not presenting with mental health disorders clinically, uh, resulting in the increased substance use disorder, but no difference in other disorders. The third is an insufficient sample size. So while this is to date, the largest study completed on mental health in this population, the cohort is still quite young. So the median age was 11.5 years old. Uh, so in both cases and controls, it's expected that more mental health disorders will manifest as these patients age. It may just be that not enough time has passed to elucidate smaller risk differences than we were anticipating between these cohorts, and we intend to continue to follow these individuals as they grow up. So, in conclusion, we're able to provide an answer for the parents of children with congenital surgical anomalies. Their child is likely not at an increased risk of mental health disorders, including anxiety or mood disorders. However, these individuals are at an increased risk of substance use disorders as they grow up, and parents should be aware of possible signs of substance misuse in their children to ensure that early intervention and care can be given to those who need it. Um, however, children with anorectal malformation specifically are at an increased risk of mental health disorders, anxiety disorders, and substance use disorders, and sufficient supports and screening needs to be put into place to ensure that these individuals have the support they need to maximize their long-term health and happiness. So in closing, I'd like to thank the patients and pediatric surgeons of the Health Sciences Center Children's Hospital who made this study possible. I'd also like to thank the Children's Hospital Research Institute of Manitoba and CIHR. Thank you very much. Hi there. Thank you so much for such an amazing presentation. This is so important, especially as we're thinking about all of these children that are, you know, now living into adulthood and interacting with the world and, and kind of what happens to those kids and families. Um, at your center, have there been any preventative strategies or interventions to target these groups that we know now that are, are really at high risk? Um, so that's a great question. Uh, to my knowledge, there have not been quite yet. So this is, uh, a, a pretty recent, recent finding. Um, and so because of that, we haven't been able to implement, um, any preventative, uh, measures quite yet. Um, I believe that the hope is to implement those in, in the coming months, in the coming years, uh, in order to really make sure that, that we do the best by our patients. Yeah. And who's following these kids as they're kind of aging into, you know, young adulthood when a lot of these, uh, mental health and substance abuse disorders kind of become more prevalent, more problematic, um, as they're aging out of pediatric care. Um, so, another, another great question. Um, I mean, for the mental health, uh, kind of side of, of these patients' care, um, this study was looking at any, any mental health diagnosis made by any medical professional. Um, so that wasn't necessarily a, a psychiatrist at like, in, in our case, the big, uh, Quaternary Center, um, the Health Sciences Center, um, but also community, uh, like community family doctors, uh, community psychiatrists. Um, so there are quite a few, um, We, we weren't able to isolate who, who was caring for these, these children and just due to how we got our data, uh, we weren't able to, um, assess, uh, who was, was most likely to be taking care of these children either. But that is a great point and that would be really interesting to follow up and, and see changes and, and differences in, in outcomes based on who's following them. I, I think this is, uh, such an important study to look at, um, beyond what you've even already shown in that historically, as pediatric surgeons, we, you know, we're done. They go off and they're somebody else's patient now. And now that we have better awareness of this concept that we're, we should, you know, know about what happens, we're, we're learning so much more. And with better EMR, We should be able to start looking at this at a larger scale for everything, you know, not only just mental health, but what are the things that we've never paid attention to once they leave our practice. This has got to open up a whole new, uh, area of research of people that spend their time following our young patients into adulthood cause it really has not been done, and we're gonna make some, some good or bad discoveries based on this. But congratulations for your work. This is a great paper. Oh, thank you very much.