Survey Results

2020

Surgical Innovation in Pediatric Surgery

  • Introduction: Pediatric surgery fellowship applicants are increasingly pursuing research in non-traditional fields.  Surgical innovation fellowships are a relatively new example and their standing among pediatric surgeons is unknown.  This study aims to evaluate the relative value pediatric surgeons place on surgical innovation experience compared to traditional research for pediatric surgery fellowship candidate.  
  • Results: 
  • Conclusion: Innovation experirence is generally viewed positively by fellowship selection committee members.  However, applicants and mentors within innovation would be benefit from focus on traditional academic outputs to ensure competitiveness.  

Surgeon Choice in Management of Pediatric Abdominal Trauma

  • Goal: To determine factors contributing to pediatric and adult trauma surgeons’ management choices of hemodynamically stable children with suspected non-solid organ abdominal injury 
  • Response Rate:  23%
  • Findings: Of 394 respondent members of EAST and APSA, 50.3% were pediatric surgeons. In management of three blunt abdominal injury scenarios (isolated, with multisystem injury, and with traumatic brain injury), 32.2%, 49.3%, and 60.7% of surgeons chose operation over observation, respectively. Compared to isolated blunt injury, surgeons were more likely to choose operation for patients with multisystem injury (aOR 2.20, 95%CI: 1.78-2.72) or TBI (aOR 3.60, 95%CI: 2.79-4.66). Pediatric surgeons were less likely to choose operation (aOR 0.32, 95%CI: 0.22-0.44). In management of penetrating injury, 39.1%, 29.5%, and 31.5% of surgeons chose observation, local wound exploration, and laparoscopy, respectively.  
  • Conclusions: Large variation exists in management of hemodynamically stable children with suspected hollow viscus injury. Although patient injury characteristics account for some variation, surgeon factors, such as type of surgeon also play a role. Evidence-based practice guidelines should be developed to standardize care.
  • Publications: Under review.
  • Elissa Butler

2019

Umbilical Hernia Repair 

  • This survey was developed to provide a better understanding of why pediatric surgeons may differ in their approach to managing asymptomatic umbilical hernias, and to provide insight into how we may reduce practice variation through the establish ment of consensus guidelines.
  • Shawn J. Rangel, MD MSCE
  • 44% Response Rate 
  • Manuscript submitted  

 

2018

Evidence Based Medicine in Pediatric Surgery

  • Goal: We have designed a survey that explores how pediatric surgeons rely on EBM in settings of relative certainty as well as in settings of clinical uncertainty. We hope this brief, 5 to 7 minute survey allows us to gain a better understanding of how pediatric surgeons rely on EBM across a variety of clinical settings so that we may develop tools to enhance decision making and clinical counseling as well as provide a framework for future studies designed to augment training for residents and fellows on incorporation of EBM into clinical practice.
  • General conclusions: 96 of respondents (47%) reported no EBM training, 89 (44%) reported EBM training, and 17 (8%) were unsure. EBM trained surgeons rely on literature more than clinical experience (56% vs. 44%; p < 0.01), a difference not appreciated in those lacking EBM training (50.2% vs. 49.8%; p = 0.88). Compared to 12% of fellows, 37% of surgeons with >10yr experience prefer to rely on clinical judgment as opposed to published evidence when discussing rare conditions (p < 0.01).
  • Erica M. Carlisle, MD
  • 15.6% Response rate 


Current Management of Pilonidal Disease in Pediatric and Adolescent Patients: An APSA Survey 

  • Pilonidal disease is often managed by pediatric surgeons. The optimal timing of intervention and type of treatment is not known. As current practice patterns change, we aim to identify current management strategies using a survey of our APSA colleagues.

Umbilical Access in Neonates and Infants Survey

  • This research study is about how pediatric surgeons access the umbilicus for laparoscopic surgery in neonates and infants up to age 3 months. We are interested in whether or not you have experienced any complications during umbilical access. Your participation in this study is voluntary and all responses will remain completely anonymous. Your participation will allow us to inform the pediatric surgical community of current practices in laparoscopic surgery, specifically related to umbilical access, as well as the potential pitfalls to the methods of umbilical access in this patient population.
  • ​​Matthew P. Landman, MD, MPH


Activity Restrictions Survey

  • Goal of survey: To see what current pediatric surgeons are prescribing for activity restrictions following general surgeries. 
  • General conclusions: There was a wide variability amongst the pediatric surgery realm. 
  • Publications: Yes, but the link is not avaiable at this time. 
  • Intersting Findings: We found that 45% of surgeons (293 respondents) believe that there should be 2-3 weeks activity restrictions, whereas only 30% there shouldn't be any. 
  • Fizan Abdullah, MD, PhD
  • 28.6% Response Rate


Pediatric Rectal Prolapse Survey 

  • Many management options exist for the treatment of medically refractory rectal prolapse in children. In order to standardize the surgical management of rectal prolapse, it is important to know what factors play a role in decision-making. To that end, we designed this short survey to characterize current practice patterns. We plan to use these data to gain new insights into the management of pediatric rectal prolapse and to inform future study. 
  • Francois Trappey, MD 

 

2017


ECMO in CDH

  • The survey asked for opinions and preferences surrounding the use of ECMO for the treatment of respiratory failure associated with CDH. The focus is to understand varying practice patterns among providers, across institutions and to examine differences in approaches.
  • Goal of survey: Identify current practice patterns regarding the use of ECMO for infants with CDH
  • General conclusions: There is a general lack of consensus regarding the use of ECMO in CDH in North America, particularly when it comes to VV-ECMO. 
  • Publications: CAPS Abstract, presentation pending
  • Intersting Findings: Perhaps the most interesting finding was the differences between neonatologists and surgeons regarding the use of VV-ECMO.
  • Items Unanswered or univestingated from survey: Optimal timing of repair on ECMO. 
  • Yigit Guner, MD
  • 18% Response Rate


Survey of FAST in Pediatric Trauma

  • Goal of survey: To examine the current ractice patterns and surgeon attitudes with regard to FAST exam in pediatric trauma. 
  • General conclusions: The FAST exam is utilized by the majority of pediatric surgeons who responded (76%), despite recent evidence that it has low sensitivity for intraabdominal injury in stable pediatric patients. FAST was more likely to be used by surgeons at Level 1 trauma centers vs. non-Level 1 facilities (75.2% vs. 57.6%, p=0.02). The implementation of FAST is seldom tracked by permanent records or QI processes. Opinions regarding FAST in children were variable with only 40% reporting they felt it was an important adjunct in pediatric trauma. Overall, respondent attitudes suggest it is most useful in the unstable patient.
  • Publications: None as of June 2018
  • Intersting Findings: We were somewhat surprised by the prevalence of FAST use among respondents given the ongoing controversy, although this may represent some bias in response by surgeons who use FAST.
  • Items Unanswered or univestingated from survey: The sensitivity and utility of FAST in unstable pediatric trauma is incompletely studied and we feel that this is likely the most important application of FAST in children.
  • Katherine Baxter, MD


Pediatric Peripheral ECMO Cannulation Technique and Safety Survey

  • Goal of survey: The goal of this survey is to characterize varying practice patterns across institutions and providers in ECMO cannulation. We plan to use these results to examine differences in technique and to compare this data with practice recommendations to gain new insights for further study.
  • General conclusions: In general, pediatric general surgeons are cannulating for both VA and VV ECMO in the ICU. Most centers are not offering specific ECMO cannulation credentialing, but having this additional certification does not change reported complication rates. VA ECMO is usually performed open and frequently without the use of any imaging guidance (surface landmarks only). VV ECMO on the other hand is often performed percutaneously, usually under guidance from either fluoroscopy, echocardiography or both. Reported estimated complication rates did not vary by cannulation strategy. In older and larger children, the femoral is preferred over the neck with or without the presence of a pre-existing femoral arterial or venous line.
  • Publications: None as of June 2018
  • Intersting Findings: We were surprised that the different techniques for assessing cannula placement were not associated with different rates of estimated complications, especially rates of needing to reposition the cannula. Additionally, a surprising number of respondents stated that they were experiencing complications up to 25-50% or more than 50% of the time. This was not expected, especially in self-reported numbers, and is concerning. Finally, we were surprised that more people were not using imaging guidance to place the cannulas, when it is readily available.
  • Items Unanswered or univestingated from survey: Because this was a survey-type study, more objective data would be important in further assessing the relationship between cannulation strategy and complication rates. Also, it will be important to continue re-evaluating practice patterns as more centers move toward requiring specific credentialing for ECMO cannulation.
  • Brian Gray, MD


Spontaneous Pneumothorax Survey

  • Goal of survey: To understand current management of primary spontaneous pneumothorax in children and adolescents. 
  • General conclusions: The majority of surgeons treat first episode of PSP with chest tube alone.  VATS is offered for a recurrence or if there is persistent air leak with chest tube.  Most surgeons wait 3 days after chest tube placement before considering VATS.  Chest CT is not routinely employed in the workup of PSP and most surgeons do not operate for blebs found incidentally on the contralateral side.  Stapled blebectomy and mechanical pleurodesis are the most commonly performed interventions when VATS is indicated.  
  • Publications: None as of June 2018
  • Intersting Findings: They did not.  
  • Items Unanswered or univestingated from survey: This survey helped us to understand current practice, but not necessarily best practice. Further efforts are needed to identify the best ways to minimize recurrence in PSP.  
  • Timothy Lautz, MD
  • 29% Response Rate


ECMO - Cannulation Preference Survey

  • This brief survey focuses specifically on evaluating femoral cannulation preferences and management by pediatric surgeons. The goal is to use these results to highlight areas of ambiguity in how children are cannulated and managed on ECMO, as well as to design prospective work to improve and simplify the management of these patients.
  • Alejandro Garcia, MD
  • 21% Response rate 
  • JPS Publication 


Global Health Initatives Survey

  • The purpose of the survey is to gather details about APSA members' current efforts with pediatric surgeons in low- and middle-incme countries (LMICs) with the aim of identifying and developing sustainable capacity-building collaborations that could be further strengthened by the support of interested APSA members.
  • APSA Global Committee
  • 0.9% Response rate 


Gastroschisis Survey

  • The University of Iowa Department of Pediatric Surgery is conducting a survey to assess the practice patterns of pediatric surgeons regarding the closure of simple gastroschisis. We also seek to understand the locations (NICU, OR, or other) in which surgeons close gastroschisis and any barriers surgeons face in operating in their preferred location.
  • Julia Shelton, MD
  • 27% Response Rate 

2016


Enhanced Recovery After Surgery

  • There is an increasing focus on providing high-value surgical care by improving outcomes while minimizing resource utilization and waste. Enhanced Recovery After Surgery, or ERAS, strategies have garnered significant attention in a variety of adult surgical populations. These perioperative protocols have been found to decrease hospital length of stay, in-hospital costs and complications and have been increasingly adopted by major hospital systems and supported by leading organizations, such as the American College of Surgeons. However, literature evaluating implementation of enhanced recovery protocols in pediatric populations is scant. The limited literature available suggests that ERAS protocols would be safe and effective when applied to the pediatric population. This survey was designed to assess beliefs regarding the applicability of individual enhanced recovery elements extrapolated from adult colon and rectal surgery guidelines.
  • Mehul Raval, MD
  • 24% Response Rate 
  • JPS Publication


APSA AAP ACS Strategic Plan 

  • The leadership of the three organizations representing Pediatric Surgery has developed the questionnaire linked below. This effort is part of a strategic initiative to improve communication between our organizations and to plan for the future of our profession. Recognizing that each organization has unique strengths but there is also overlap, we appreciate in advance your willingness to take the time to honestly answer the question.
  • APSA Survey
  • 41% Response Rate 


Neonates with NEC Survey

  • There is wide variation in opinion regarding decisions of whether to proceed with full medical and surgical treatment or comfort care in infants with severe necrotizing enterocolitis and massive bowel loss. In the past decade, long-term outcomes of intestinal failure in children have improved dramatically. We are seeking your thoughts on the optimal care for infants with massive bowel loss from necrotizing enterocolitis. This study is being conducted by neonatologists and pediatric surgeons at Seattle Children's Hospital and University of Washington Medical Center.
  • Patrick Javid, MD
  • 28% Response Rate 


Satisfaction Survey 

  • The APSA Membership and Credentials Committee is sponsoring a job satisfaction survey of our new members who have completed their training within the last five years. Our goal is to identify factors in first employment positions that may have led some people to seek out alternative employment within their first five years of practice. With this information, we hope to be able to identify factors of jobs that are attractive to candidates and lead to fruitful and fulfilling careers, as well as factors that may not be so appealing that would lead candidates to seek employment elsewhere. 
  • APSA Membership Committee
  • 47% Response Rate


Pulmonary Osteosarcoma Survey

  • In an attempt to improve the thoracic surgical care of patients with metastatic osteosarcoma, surgeons in the Children’s Oncology Group (COG) are advocating for a cooperative group study.  This prospective study would collect information on surgical management and clinical outcomes, and to correlate imaging findings with operative findings.  Challenges in this study include the rarity of the problem, the advances in diagnostic imaging over long study periods, changing chemotherapy regimens, and institutional preferences and biases in surgical approach.
  • John Doski, MD
  • 17% Response Rate
  • Used for COG Research Grant 


Safety Attitudes Survey

  • In an attempt to define the future safety agenda of the APSA Surgical Quality and Safety Committee, a brief survey has been developed to assess the attitudes, perceptions and practices of the APSA membership surrounding safe surgical care. Furthermore, we hope to identify novel or innovative practices that have been particularly effective at member hospitals so that we may possibly share these with the broader APSA community. In this regard, you will have the option of leaving your contact information at the end of the survey if you wish to tell us more.
  • APSA Surgery and Quality Committee
  • 38% Response Rate