Pediatric surgery – a changing field: national trends in pediatric surgical practice

Bruns, Nicholas E.; Shah, Manoj; Dorsey, Amelia N.; Ponsky, Todd A.; Soldes, Oliver S.

doi:10.1016/j.jpedsurg.2016.02.079

Cited by 30 publications

(15 citation statements)

References 11 publications

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“…Many see a changing paradigm in the number and types of cases that are seen at academic institutions [14]. Some feel that there will be too many pediatric surgeons in the future, and that the index case loads of these individuals will be diluted.…”

Section: Discussionmentioning

confidence: 99%

Endangered academia: preserving the pediatric surgeon scientist

Markel

Valsangkar

Bell

et al. 2017

Journal of Pediatric Surgery

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Background: Pediatric surgery is one of the most difficult surgical fellowships to obtain. It requires stellar academic credentials and, often, dedicated time pursuing research. It is unknown, however, if pediatric surgeons maintain high academic output as faculty members. We hypothesized that the majority of pediatric surgeons do not pursue robust research activities as faculty, and therefore, over time, their academic productivity decreases. Methods: Numbers of publications, citations, H-index, and NIH funding rates were determined for 4354 surgical faculty at the top-55 NIH based departments of surgery using websites, Scopus, NIH RePORTER, and Grantome. Continuous variables were compared with ANOVA and post-hoc Bonferroni; categorical variables by χ2 test. p < 0.05 was significant. Results: In this dataset, 321 pediatric surgery (PS) faculty represented 7.4% of the cohort. Among PS faculty, 31% were assistant professors, 24% associate professors, 31% full professors and 13% had no academic rank. PS faculty had significantly more publications, a higher H index, and more high level NIH funding early in their careers at the assistant professor level compared to general surgeons. PS faculty at the associate professor level had equivalent high level NIH funding, but lower recentness and academic power compared to general surgeons. Professors of PS rebounded slightly, with only observed deficiencies in number of citations compared to general surgeons. Conclusions: PS faculty in assistant professor ranks has higher scholarly productivity compared to equivalently ranked general surgeons. Despite some mild academic setbacks in midcareer, pediatric surgeons are able to maintain similar academic productivity to their general surgery colleagues by the time they are full professors. Level of evidence: 2.

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Section: Discussionmentioning

confidence: 99%

Endangered academia: preserving the pediatric surgeon scientist

Markel

Valsangkar

Bell

et al. 2017

Journal of Pediatric Surgery

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“…Skin and soft tissue infection is a problem often encountered by ED doctors and pediatric surgeons. Treatment includes making an incision of approximately 1 cm on the skin for drainage and irrigation of the abscess and when necessary the placement of a mesh, then follow-up with antibiotic therapy (2,3). There are many references in literature stating that pediatric group patients can be discharged following the necessary skin incision and drainage of skin abscess (5).…”

Section: Discussionmentioning

confidence: 99%

“…When these infections become an abscess, there may be a need for intervention by a pediatric surgeon. The traditional treatment method for abscess is to make an incision of approximately 1-1.5cm in the skin, drain the abscess, apply irrigation to the abscess pouch and if necessary place a mesh in the pouch and follow up with antibiotic therapy (2,3). The majority of patients applied with incision and drainage can be discharged on the same day with antibiotic therapy following the necessary procedures, but potential complications should always be kept in mind (4,5).…”

Section: Introductionmentioning

confidence: 99%

An uncommon complication in the drainage of a chest wall skin abscess: pneumothorax and subcutaneous emphysema

Demirel¹,

Mohamed²,

Ali³

et al. 2018

Medical Science and Discovery

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Objective: Skin and soft tissue infections are frequent cases of emergency services. Treatment of these patients is usually performed ambulatory in the form of abscess drainage and oral antibiotic therapy. In this article, it was aimed to draw attention to the fact that a rib fracture may be seen after an abscess drainage made by inexperienced persons and that might lead to presentation with more complicated situation.

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“…In adult practice, fundoplication has become a popular means of managing GORD when medical therapy fails; its efficacy in control of GORD has been established in numerous RCTs. Evidence for its use in children is less robust, yet fundoplication remains one of the most common index operations in paediatric surgery in the USA. Concerns have been raised that antireflux surgery (ARS) is being performed by surgeons without a full structured assessment of GORD.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of antireflux surgery in children with or without neurological impairment: a systematic review

Cullis

Siminas

Losty

2020

British Journal of Surgery

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Background: Antireflux surgery is commonly performed in children, yet evidence for its efficacy is limited. The aim of this review was to determine the effect of antireflux surgery with regard to objective measures of quality of life (QoL) and value of upper gastrointestinal investigations in neurologically normal (NN) and neurologically impaired (NI) children. Methods: A systematic review was conducted of articles reporting children undergoing antireflux surgery in whom preoperative and postoperative objective testing was performed. Primarily, Embase, CINAHL, MEDLINE and PubMed were searched from inception to April 2019. Methodological Index for Non-randomized Studies (MINORS) criteria were used to assess article quality. Results: Of 789 articles, 14 met the eligibility criteria, 12 prospective observational and 2 retrospective studies. The median MINORS score was 59⋅4 (i.q.r. 39 to 62⋅5) per cent. Seven studies reported assessment of validated QoL measures before and after antireflux surgery in 148 children. Follow-up ranged from 1 to 180 months. All studies confirmed significant improvements in QoL measures among NN and NI children at all follow-up points. Eleven studies reported on preoperative and postoperative investigations in between 416 and 440 children children. Follow-up ranged from 0⋅5 to 180 months. Nine studies confirmed improvements in gastro-oesophageal reflux using 24-h oesophageal pH monitoring with or without manometry, but conflicting results were identified for four studies reporting gastric emptying. No studies reported fluoroscopy or endoscopy adequately. Conclusion: Based on the results of studies of low-to-moderate quality, antireflux surgery improved QoL and reduced oesophageal acid exposure in NN and NI children in the short and medium term. Although antireflux surgery is a common elective operation, the lack of rigorous preoperative and postoperative evaluation(s) in the majority of patient-reported studies is striking.

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Pediatric surgery – a changing field: national trends in pediatric surgical practice

Cited by 30 publications

References 11 publications

Endangered academia: preserving the pediatric surgeon scientist

Endangered academia: preserving the pediatric surgeon scientist

An uncommon complication in the drainage of a chest wall skin abscess: pneumothorax and subcutaneous emphysema

Efficacy of antireflux surgery in children with or without neurological impairment: a systematic review

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