Aaron J Cunningham1, Katrine M Lofberg2, Sanjay Krishnaswami1, Marilyn W Butler3, Kenneth S Azarow1, Nicholas A Hamilton1, Elizabeth A Fialkowski1, Pamela Bilyeu4, Erika Ohm5, Erin C Burns6, Margo Hendrickson7, Preetha Krishnan8, Cynthia Gingalewski5, Mubeen A Jafri9. 1. Division of Pediatric Surgery, Doernbecher Children's Hospital, Oregon Health Science University, Portland, OR. 2. Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, AZ. 3. Division of Pediatric Surgery, Doernbecher Children's Hospital, Oregon Health Science University, Portland, OR; Division of Pediatric Surgery, Randall Children's Hospital at Legacy Emanuel, Portland, OR. 4. Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR. 5. Division of Pediatric Surgery, Randall Children's Hospital at Legacy Emanuel, Portland, OR. 6. Department of Pediatrics, Critical Care, Doernbecher Children's Hospital, Oregon Health Science University, Portland, OR. 7. Division of Pediatric Surgery, Kaiser Permanente Northwest, Portland, OR. 8. Department of Pediatrics, Critical Care, Randall Children's Hospital at Legacy Emanuel, Portland, OR. 9. Division of Pediatric Surgery, Doernbecher Children's Hospital, Oregon Health Science University, Portland, OR; Division of Pediatric Surgery, Randall Children's Hospital at Legacy Emanuel, Portland, OR. Electronic address: jafri@ohsu.edu.
Abstract
BACKGROUND: An expedited recovery protocol for management of pediatric blunt solid organ injury (spleen, liver, and kidney) was instituted across two Level 1 Trauma Centers, managed by nine pediatric surgeons within three hospital systems. METHODS: Data were collected for 18months on consecutive patients after protocol implementation. Patient demographics (including grade of injury), surgeon compliance, National Surgical Quality Improvement Program (NSQIP) complications, direct hospital cost, length of stay, time in the ICU, phlebotomy, and re-admission were compared to an 18-month control period immediately preceding study initiation. RESULTS: A total of 106 patients were treated (control=55, protocol=51). Demographics were similar among groups, and compliance was 78%. Hospital stay (4.6 vs. 3.5days, p=0.04), ICU stay (1.9 vs. 1.0days, p=0.02), and total phlebotomy (7.7 vs. 5.3 draws, p=0.007) were significantly less in the protocol group. A decrease in direct hospital costs was also observed ($11,965 vs. $8795, p=0.09). Complication rates (1.8% vs. 3.9%, p=0.86, no deaths) were similar. CONCLUSIONS: An expedited, hemodynamic-driven, pediatric solid organ injury protocol is achievable across hospital systems and surgeons. Through implementation we maintained quality while impacting length of stay, ICU utilization, phlebotomy, and cost. Future protocols should work to further limit resource utilization. TYPE OF STUDY: Retrospective cohort study. LEVEL OF EVIDENCE: Level II.
BACKGROUND: An expedited recovery protocol for management of pediatric blunt solid organ injury (spleen, liver, and kidney) was instituted across two Level 1 Trauma Centers, managed by nine pediatric surgeons within three hospital systems. METHODS: Data were collected for 18months on consecutive patients after protocol implementation. Patient demographics (including grade of injury), surgeon compliance, National Surgical Quality Improvement Program (NSQIP) complications, direct hospital cost, length of stay, time in the ICU, phlebotomy, and re-admission were compared to an 18-month control period immediately preceding study initiation. RESULTS: A total of 106 patients were treated (control=55, protocol=51). Demographics were similar among groups, and compliance was 78%. Hospital stay (4.6 vs. 3.5days, p=0.04), ICU stay (1.9 vs. 1.0days, p=0.02), and total phlebotomy (7.7 vs. 5.3 draws, p=0.007) were significantly less in the protocol group. A decrease in direct hospital costs was also observed ($11,965 vs. $8795, p=0.09). Complication rates (1.8% vs. 3.9%, p=0.86, no deaths) were similar. CONCLUSIONS: An expedited, hemodynamic-driven, pediatric solid organ injury protocol is achievable across hospital systems and surgeons. Through implementation we maintained quality while impacting length of stay, ICU utilization, phlebotomy, and cost. Future protocols should work to further limit resource utilization. TYPE OF STUDY: Retrospective cohort study. LEVEL OF EVIDENCE: Level II.
Authors: Sarah C Stokes; Erin G Brown; Jordan E Jackson; David E Leshikar; Jacob T Stephenson Journal: Pediatr Surg Int Date: 2021-03-29 Impact factor: 1.827
Authors: Allie E Steinberger; Nicole A Wilson; Connor Fairfax; Stephanie J Treon; Michele Herndon; Tamar L Levene; Martin S Keller Journal: Surg Open Sci Date: 2021-05-03