Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2025

The tracheobronchopexy series included 80 patients, which is a huge number - most pediatric surgeons won't see 10 of these patients in their career, and many wouldn't see 5

In experienced hands who have done numerous or hundreds of these type procedures, tracheobronchopexy can have very good outcomes for patients with severe airway collapse symptoms

Canada is the 2nd largest country in the world geographically, though population-wise smaller than California

The majority of Canada's population lives within 200 kilometers of the US border, but there are definitely lots of children in remote communities where it is not easy to access care

Outreach services were present in only 7 out of 10 provinces, and only 8 out of 18 children's hospitals (44%) provided outreach services

In most places in Canada, no one would ever transfer a 16 or 17 year old with appendicitis to a children's hospital for surgery - physiologically and every other way they're an adult and clearly do not need the expertise of a pediatric surgeon

Access to surgical care for children in Canada has been in need of improvement for decades

It's a misconception that the Canadian healthcare system ensures timely care - it actually doesn't, and children wait for surgery beyond their wait time target

Newfoundland and Labrador has the best outreach setup with only two pediatric surgeons who have established outreach clinics all over the province, serving as a model for others

The population of Newfoundland and Labrador is really rural and spread out, and geographically and weather-wise it can be impossible sometimes to access care or financially devastating

There are measurable costs in terms of time required to be seen and actual clinical outcomes for patients living remote from accessible high quality care

In the NSQIP database, 5% of all pediatric procedures were G-tube, which is a pretty sizable percent

77% of G-tube cases were first-time G-tubes as opposed to redos

The heterogeneity in use of preoperative upper GIs was extremely broad with no real reason for it, indicating a potential teaching moment

An additional 5.5% of G-tubes were dislodged in the 31 to 60 day period

Dislodgement rates are higher than rates of readmissions or IR interventions, making them a great QI target

If you can get dislodgements down, ED visits go down - when dislodgements happen early, patients are told to come back to the ED