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Background The purpose of this study was to quantify disparities in the utilization of outpatient pediatric surgical care and to examine the extent to which neighborhood-level socioeconomic disadvantage is associated with access to care among children. Methods Clinic "no-shows" were examined among children scheduled from 2017 to 2019 at seven pediatric surgery clinics associated with a tertiary care children's hospital. The association between Area Deprivation Index, a neighborhood-level measure of socioeconomic disadvantage, and other patient factors with clinic no-shows was examined using multivariable logistic regression models. Difficulties in accessing postoperative care in particular were explored in a subgroup analysis of postoperative (within 90 days) clinic visits after appendectomy or inguinal/umbilical hernia repairs. Results Among 10,162 patients, 16% had at least 1 no-show for a clinic appointment. Area Deprivation Index (most deprived decile adjusted odds ratio 3.17, 95% confidence interval 2.20–4.58, P< .001), Black race (adjusted odds ratio 3.30, 95% confidence interval 2.70–4.00, P< .001), and public insurance (adjusted odds ratio 2.75, 95% confidence interval 2.38–3.31, P< .001) were associated with having at least 1 no-show. Similar associations were identified among 2,399 children scheduled for postoperative clinic visits after undergoing appendectomy or inguinal/umbilical hernia repair, among whom 20% were a no-show. Conclusion Race, insurance type, and neighborhood-level socioeconomic disadvantage are associated with disparities in utilization of outpatient pediatric surgical care. Challenges accessing routine outpatient care among disadvantaged children may be one mechanism through which disparate outcomes result among children requiring surgical care.
Ryan J. Powers; Ali A. Mokdad; Liliana E. Pezzin; Ann B. Nattinger; Keith T. Oldham; Kyle J. Van Arendonk. Disparities in utilization of outpatient surgical care among children. Surgery 2021, 1 .
AMA StyleRyan J. Powers, Ali A. Mokdad, Liliana E. Pezzin, Ann B. Nattinger, Keith T. Oldham, Kyle J. Van Arendonk. Disparities in utilization of outpatient surgical care among children. Surgery. 2021; ():1.
Chicago/Turabian StyleRyan J. Powers; Ali A. Mokdad; Liliana E. Pezzin; Ann B. Nattinger; Keith T. Oldham; Kyle J. Van Arendonk. 2021. "Disparities in utilization of outpatient surgical care among children." Surgery , no. : 1.
Catherine Bodnar; Radek Buss; Kimberly Somers; Ali Mokdad; Kyle J Van Arendonk. Association of Neighborhood Socioeconomic Disadvantage With Complicated Appendicitis in Children. 2021, 265, 245 -251.
AMA StyleCatherine Bodnar, Radek Buss, Kimberly Somers, Ali Mokdad, Kyle J Van Arendonk. Association of Neighborhood Socioeconomic Disadvantage With Complicated Appendicitis in Children. . 2021; 265 ():245-251.
Chicago/Turabian StyleCatherine Bodnar; Radek Buss; Kimberly Somers; Ali Mokdad; Kyle J Van Arendonk. 2021. "Association of Neighborhood Socioeconomic Disadvantage With Complicated Appendicitis in Children." 265, no. : 245-251.
Introduction Simultaneous gastrostomy tube (GT) and tracheostomy placement in young children offers potential benefit in limiting anesthetic exposure, but it is unknown whether combining these procedures introduces additional morbidity. This study compared outcomes after combined GT and tracheostomy placement versus GT placement alone among similar ventilator-dependent patients. Methods Ventilator-dependent children <2-years-old who underwent GT placement alone (MV-GT), simultaneous GT and tracheostomy placement (GT+T), and GT placement alone with a pre-existing tracheostomy (T-GT) were identified using 2012–2018 NSQIP-Pediatric Participant User Files. Multiple logistic regression models were used to compare outcomes while adjusting for other group differences. Results Among 1100 children, 351 underwent MV-GT, 494 GT+T, and 255 T-GT. Major complications occurred in 23.6%, 17.0%, and 14.5% of the respective groups (p = 0.01). Major complications with GT+T were similar to T-GT (adjusted odds ratio [aOR]=1.19, 95%CI:0.78–1.83, p = 0.4) and lower than MV-GT (aOR=0.67, 95%CI:0.47–0.95, p = 0.02). Severe complications including mortality, cardiac arrest, and stroke were similar between the three groups (p = 0.8). Conclusions Children <2-years-old undergoing GT+T did not experience higher post-operative complications compared to children undergoing T-GT or MV-GT. Utilizing GT+T to limit anesthetic exposure may be reasonable within this high-risk population. Type of Study Treatment Study Level of Evidence Level III
Christina M. Bence; Jose H. Salazar; Katherine T. Flynn-O'Brien; Ali A. Mokdad; David M. Gourlay; Kyle J. Van Arendonk. Outcomes of gastrostomy placement with and without concomitant tracheostomy among ventilator dependent children. Journal of Pediatric Surgery 2021, 56, 1222 -1226.
AMA StyleChristina M. Bence, Jose H. Salazar, Katherine T. Flynn-O'Brien, Ali A. Mokdad, David M. Gourlay, Kyle J. Van Arendonk. Outcomes of gastrostomy placement with and without concomitant tracheostomy among ventilator dependent children. Journal of Pediatric Surgery. 2021; 56 (7):1222-1226.
Chicago/Turabian StyleChristina M. Bence; Jose H. Salazar; Katherine T. Flynn-O'Brien; Ali A. Mokdad; David M. Gourlay; Kyle J. Van Arendonk. 2021. "Outcomes of gastrostomy placement with and without concomitant tracheostomy among ventilator dependent children." Journal of Pediatric Surgery 56, no. 7: 1222-1226.
Introduction The role of advanced care practitioners (ACPs) in pediatric surgery is increasingly important and not well described. Methods Electronic surveys were sent to pediatric surgery division chiefs within the Children's Hospital Association. Results We received 77/163 survey responses (47%). The median number of ACPs per service was 3.0 (range 0-35). ACP number correlated with inpatient census, surgeon number, case volume, trauma centers, intensive care unit status, and fellowship programs but not with presence of residents/hospitalists, hospital setting, or practice type. Nearly all programs incorporated nurse practitioners while almost half utilized physician assistants. Approximately one-third of ACPs were designated for subspecialties (35%) such as trauma and colorectal. Only 9% of centers had surgeon-specific ACPs. ACP responsibilities included both inpatient and outpatient tasks. Nearly all ACPs participated in procedures (89%), mostly bedside (80%). All ACPs worked daytime shifts, with less nights and weekends. Most ACPs billed for services (80%). Satisfaction with ACP coverage was widespread and did not correlate with ACP number. Most respondents felt that ACPs enhance, and not hinder, resident/fellow training (85%). Conclusion ACPs are useful adjuncts in pediatric surgery. A better understanding of practice patterns may help optimize utilization to enhance patient care and can be used to advocate for appropriate resources.
Barrie S. Rich; Joanna Fishbein; Robert L. Ricca; Kevin P. Moriarty; Joshua Short; Maeve O'neill Trudeau; Stephen S. Kim; Michael Rollins; Kyle J. Van Arendonk; Samir K. Gadepalli; Mehul V. Raval; Roshni Dasgupta; David H. Rothstein; Richard D. Glick. Defining the role of advanced care practitioners in pediatric surgery practice. Journal of Pediatric Surgery 2020, 1 .
AMA StyleBarrie S. Rich, Joanna Fishbein, Robert L. Ricca, Kevin P. Moriarty, Joshua Short, Maeve O'neill Trudeau, Stephen S. Kim, Michael Rollins, Kyle J. Van Arendonk, Samir K. Gadepalli, Mehul V. Raval, Roshni Dasgupta, David H. Rothstein, Richard D. Glick. Defining the role of advanced care practitioners in pediatric surgery practice. Journal of Pediatric Surgery. 2020; ():1.
Chicago/Turabian StyleBarrie S. Rich; Joanna Fishbein; Robert L. Ricca; Kevin P. Moriarty; Joshua Short; Maeve O'neill Trudeau; Stephen S. Kim; Michael Rollins; Kyle J. Van Arendonk; Samir K. Gadepalli; Mehul V. Raval; Roshni Dasgupta; David H. Rothstein; Richard D. Glick. 2020. "Defining the role of advanced care practitioners in pediatric surgery practice." Journal of Pediatric Surgery , no. : 1.
Although gastrostomy placement is one of the most common procedures performed in children, the optimal technique remains unclear. The purpose of this study was to evaluate variability in the method of gastrostomy tube placement in children in the United States. Patients
Jose H. Salazar; Charles Spanbauer; Manu R. Sood; John C. Densmore; Kyle J. Van Arendonk. Variability in the Method of Gastrostomy Placement in Children. Children 2020, 7, 53 .
AMA StyleJose H. Salazar, Charles Spanbauer, Manu R. Sood, John C. Densmore, Kyle J. Van Arendonk. Variability in the Method of Gastrostomy Placement in Children. Children. 2020; 7 (6):53.
Chicago/Turabian StyleJose H. Salazar; Charles Spanbauer; Manu R. Sood; John C. Densmore; Kyle J. Van Arendonk. 2020. "Variability in the Method of Gastrostomy Placement in Children." Children 7, no. 6: 53.
This chapter describes the critical concepts for the Fowler-Stephens procedure as performed by the open and laparoscopic approaches. The text includes an introduction that outlines the indications, risks, alternatives, essential steps, necessary equipment, and variations in technique. This is followed by a template operative dictation, which provides the reader with an operative report, such as is found in a patient chart or electronic medical record.
Kyle J. Van Arendonk; Dai H. Chung. Fowler-Stephens Procedure. Operative Dictations in Pediatric Surgery 2019, 207 -212.
AMA StyleKyle J. Van Arendonk, Dai H. Chung. Fowler-Stephens Procedure. Operative Dictations in Pediatric Surgery. 2019; ():207-212.
Chicago/Turabian StyleKyle J. Van Arendonk; Dai H. Chung. 2019. "Fowler-Stephens Procedure." Operative Dictations in Pediatric Surgery , no. : 207-212.
Neuroblastoma, the most common extracranial solid tumor of childhood, has widely variable outcomes dependent on the specific biology of the tumor. In this review, current biologic principles that are used to stratify risk and guide treatment algorithms are discussed. The role for surgical resection in neuroblastoma is also reviewed, including the indications and timing of surgery within the greater treatment plan.
Kyle Van Arendonk; Dai Chung. Neuroblastoma: Tumor Biology and Its Implications for Staging and Treatment. Children 2019, 6, 12 .
AMA StyleKyle Van Arendonk, Dai Chung. Neuroblastoma: Tumor Biology and Its Implications for Staging and Treatment. Children. 2019; 6 (1):12.
Chicago/Turabian StyleKyle Van Arendonk; Dai Chung. 2019. "Neuroblastoma: Tumor Biology and Its Implications for Staging and Treatment." Children 6, no. 1: 12.
Hannah M. Phelps; Josephine M. Ndolo; Kyle J. Van Arendonk; Hannah L. Dietrich; Katherine D. Watson; Melissa A. Hilmes; Dai H. Chung; Harold N. Lovvorn. Association Between Image-Defined Risk Factors and Neuroblastoma Outcomes. Journal of the American College of Surgeons 2018, 227, S193 .
AMA StyleHannah M. Phelps, Josephine M. Ndolo, Kyle J. Van Arendonk, Hannah L. Dietrich, Katherine D. Watson, Melissa A. Hilmes, Dai H. Chung, Harold N. Lovvorn. Association Between Image-Defined Risk Factors and Neuroblastoma Outcomes. Journal of the American College of Surgeons. 2018; 227 (4):S193.
Chicago/Turabian StyleHannah M. Phelps; Josephine M. Ndolo; Kyle J. Van Arendonk; Hannah L. Dietrich; Katherine D. Watson; Melissa A. Hilmes; Dai H. Chung; Harold N. Lovvorn. 2018. "Association Between Image-Defined Risk Factors and Neuroblastoma Outcomes." Journal of the American College of Surgeons 227, no. 4: S193.