Update Course 2021: UPDATE COURSE 2020: REVIEW OF LAST YEAR'S IMPORTANT T OPICS

26% of respondents use intraoperative ICG to visualize the biliary tree, 23% use it in select patients, and 51% do not use it.

MMP7 is a send-out test at many non-freestanding children's hospitals, limiting its clinical utility for time-sensitive biliary atresia diagnosis in children presenting at five weeks of age.

For a hypotensive, tachycardic pediatric blunt trauma patient who has received 20 cc/kg crystalloid, the next steps should be early blood therapy and potentially massive transfusion protocol with balanced resuscitation, consistent with ATLS guidelines.

There is currently no great definition of what constitutes a massive transfusion protocol (MTP) in pediatric patients; approximately 40 cc/kg blood triggers consideration of balanced resuscitation.

For rectal prolapse sclerotherapy, 46% of respondents use hypertonic saline, while 10-16% use phenol, ethyl alcohol, or dextrose in water.

Getting phenol into the operating room for sclerotherapy is not always easy due to institutional and pharmacy restrictions.

3% sotradecal is used as a sclerotherapy agent for rectal prolapse.

D50 (dextrose 50% from the code cart) is used as a hypertonic sclerotherapy agent and may be easier to acquire in the operating room than 3% saline.

Approximately 50% of respondents always use sutureless abdominal closure for large abdominal wall defects, 40% use it in select patients, and only 11% do not use it.

The adoption of sutureless closure for abdominal wall defects represents a major practice change over nine years, with 90% now using it always or selectively compared to much lower rates previously.

ERAS (Enhanced Recovery After Surgery) is a bundle of interventions to help patients get through the hospital faster with less pain and fewer narcotics, including early mobilization.

ERAS protocols include giving patients a carbohydrate drink two hours before surgery, replacing traditional NPO requirements.

Implementing ERAS requires team buy-in, particularly from anesthesiologists, because of practice changes like allowing oral intake two hours preoperatively.

ERAS protocols are difficult to implement because they require the whole hospital to adopt a different culture and philosophy, unlike single-procedure changes like sutureless gastroschisis closure.

Starting ERAS implementation with surgical pathways standardizes care and has led to decreased cost, antibiotic utilization, and length of stay; hospitalists and pediatric residents use surgical pathways more than other pathways.

A strategy for ERAS implementation is to chip away at individual components (such as decreasing opioid use intraoperatively and perioperatively) before building a larger protocol.

For bleeding from a pulmonary vessel during thoracoscopic lobectomy, start with an energy/sealing device (effective in low-pressure systems), then escalate to clips or sutures if needed.

Multiple hemostasis options (energy, clips, sutures) should be available during thoracoscopic procedures.

Most institutions are either taking steps to address social determinants of health or working on it; few report no action.