Purpose The purpose of this study was to examine risk-adjusted associations between race and gender on postoperative morbidity, mortality, and resource utilization in pediatric surgical patients within the United States. Methods 91,891 pediatric surgical patients were evaluated using the U.S. national KID Inpatient Database (2003 and 2006): appendectomy (81.2%), pyloromyotomy (9.8%), intussusception (6.2%), decortication (1.9%), congenital diaphragmatic hernia repair (0.7%), and colonic resection for Hirschsprung’s disease (0.2%). Patients were stratified according to gender (male: 62.6%, n=57,557) and race: white (n=52,334), Hispanic (n=25,697), black (n=6,951), Asian (n=1,855), Native American (n=470), and other (n=4,584). Multivariable logistic regression modeling was utilized to evaluate risk-adjusted associations between race, gender, and outcomes. Results After risk-adjustment, race was independently associated with in-hospital death (p=0.02), with an increased risk for black children. Gender was not associated with mortality (p=0.77). Post-operative morbidity was significantly associated with gender (p<0.001) and race (p=0.008). Gender (p=0.003) and race (p<0.001) were further associated with increased hospital length of stay. Importantly, these results were dependent on operation type. Conclusion Race and gender significantly affect post-operative outcomes following pediatric surgery. Black patients are at disproportionate risk for post-operative mortality, while black and Hispanic patients have increased morbidity and hospital resource utilization. While gender does not affect mortality, gender is a determinant of both post-operative morbidity and increased resource utilization.

No abstract

ObjectiveEarlier diagnosis and treatment of necrotizing enterocolitis (NEC) in preterm infants, prior to clinical deterioration, might improve outcomes. A monitor that measures abnormal heart rate characteristics (HRC) of decreased variability and repetitive decelerations was developed as an early warning system for sepsis. Since NEC shares pathophysiologic features with sepsis, we tested the hypothesis that abnormal HRC occur prior to clinical diagnosis of NEC.Study DesignRetrospective review of Bells stage II to III NEC cases among infants <34 weeks gestation enrolled in a prospective randomized clinical trial of HRC monitoring at 3 neonatal intensive care units.ResultsOf 97 infants with NEC and HRC data, 33 underwent surgical intervention within one week of diagnosis. The baseline HRC index from 1 to 3 days before diagnosis was higher in patients who developed surgical versus medical NEC (2.06 ± 1.98 vs. 1.22 ± 1.10, p=0.009). The HRC index increased significantly 16 hours prior to the clinical diagnosis of surgical NEC and 6 hours prior to medical NEC. At the time of clinical diagnosis, the HRC index was higher in patients with surgical versus medical NEC (3.3 ± 2.2 vs 1.9 ± 1.7, p<0.001).ConclusionsAbnormal HRC occur before clinical diagnosis of NEC, suggesting that continuous HRC monitoring may facilitate earlier detection and treatment.

Data sharingThe Children's Oncology Group Data Sharing policy describes the release and use of Children's Oncology Group individual subject data for use in research projects in accordance with National Clinical Trials Network (NCTN) Program and NCI Community Oncology Research Program (NCORP) guidelines. Only data expressly released from the oversight of the relevant Children's Oncology Group Data and Safety Monitoring Committee are available to be shared. Data sharing will ordinarily be considered only after the primary study manuscript is accepted for publication. For phase 3 studies, individual-level de-identified datasets that would be sufficient to reproduce results provided in a publication containing the primary study analysis can be requested from the NCTN/ NCORP data archive. Data are available to researchers who wish to analyse the data in secondary studies to enhance the public health benefit of the original work and agree to the terms and conditions of use. For non-phase 3 studies, data are available following the primary publication. An individual-level de-identified dataset containing the variables analysed in the primary results paper can be expected to be available upon request. Requests for access to Children's Oncology Group protocol research data should be sent to:

No abstract