Welcome to the Eastern Pediatric Surgery Network

The management of long-gap esophageal atresia remains controversial and has traditionally been based on surgeon preference rather than on evidence-based guidelines. Current options for surgical repair include delayed primary repair, the Foker procedure and other traction techniques, and esophageal replacement. This EPSN study is a retrospective and prospective data registry aimed at describing patient characteristics, management strategies, and outcomes after surgical repair of long-gap esophageal atresia. 

(Lead Center: Connecticut Children's).

Appendicitis is responsible for the greatest burden of surgical site infections and antibiotic utilization in pediatric surgery. This EPSN study uses the NSQIP-P database combined with electronic medical record data to analyze mandatory vs. white blood cell count-dependent antibiotic treatment strategies, two of the common approaches used in the postoperative management of complicated appendicitis. 

(Lead Center: Boston Children's).

The most common method for evaluating the severity of pectus excavatum prior to surgical repair is by cross-sectional imaging using either computed tomography  or magnetic resonance imaging. Recently, our group has developed a clinic-based measurement, known as the Modified Percent Depth (MPD), as an alternative approach to assessing the severity of pectus defects. The MPD is easy to calculate using chest calipers and has been shown to be highly accurate. Moreover, the use of MPD measurements in lieu of imaging would reduced health care costs and avoid ionizing radiation. This EPSN prospective study seeks to validate the MPD in determining the risk of pectus excavatum. 

(Lead Center: Johns Hopkins All Children's).

A significant risk of long-term parenteral nutrition is the development of a central line-associated bloodstream infections (CLABSI), a potentially life-threatening infection that can lead to septic shock, multi-system organ failure, and death. Children with suspected CLABSI are admitted, treated empirically with intravenous antibiotics, and monitored until blood culture results become available. However, these practices are not data-driven and are associated with unnecessary time in the hospital and added costs for the hospital and families. This EPSN prospective observational study investigates the effectiveness and cost reductions associated with a 24-hr hospital admission to safely rule out CLABSI and seeks to identify subpopulations that may require longer hospitalization. 

(Lead Center: Boston Children's). 

Telemedicine has been increasingly used in hospitals across the country to safely continue patient care at a distance in the context of the global pandemic. Even prior to the pandemic, it was a cost-effective way to expand to areas with decreased healthcare resources and allow for continued follow-up of patients. In the pediatric surgery population, it has allowed families more flexibility in scheduling, less time off from work in planning for a visit, and decreased travel time.  Barriers to its widespread use often include regulatory and technical support, inadequate reimbursement, and lack of insurance for liability coverage. This EPSN study aims to ascertain physician and patient experience and satisfaction with the use of telemedicine across multiple institutions, types of centers, and types of visits. It will evaluate the benefits as well as barriers in its current form, in order to have targeted goals to continue its use in pediatric surgery beyond the pandemic.  

(Lead Center: Children's National Medical Center)

The incidence of pediatric and adolescent thyroid cancer is increasing nationwide and represents a diagnostic and treatment dilemma for many pediatric providers.  Among 15-19 year olds, thyroid cancer is the eight most frequently diagnosed cancer with a higher malignancy risk (20-25% vs 5-10% in adults) in biopsied nodules. Adolescents are more likely to have extra thyroidal extension, lymph node involvement, and metastases than adults. Early diagnosis and appropriate surgical treatment is imperative. Our multi-center thyroid study is a cohort validation study of the 2017 Bethesda Classification System in pediatric thyroid nodules with three primary aims: to create a prospective multi-institution database of pediatric and adolescent patients undergoing thyroid surgery and/or thyroid nodule biopsy, to characterize rates of pediatric thyroid malignancy in this sample, and to assess current rates of  molecular profiling of indeterminate nodules in the pediatric population.

(Lead Center: Massachusetts General Hospital)

Gastroesophageal reflux is a normal physiologic process in infant and about 6% do not improve requiring medical and surgical intervention. Current guidelines from the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) recommend Nissen fundoplication for gastrointestinal reflux refractory to medical treatment. These guidelines note a lack of evidence in the literature to support transpyloric or jejunal feeding in infants and children. Most studies comparing the outcomes of these interventions are outdated, with the last meta-analysis comparing all three techniques dating back from prior to 2012. Given significant improvements in both technology and surgical expertise, most notably the advancement of laparoscopic techniques and image-guided therapies in the primary placement of post-pyloric surgical feeding tubes, it would be beneficial to revisit the decision making algorithm and outcomes for each procedure.

(Lead Center: Columbia University)

In the adult surgical population, the standard of care for elective colon and rectal operative procedures has been to perform a preoperative bowel preparation in attempt to decrease the risk of post-operative complications. Data in adult populations support the use of non-absorbable oral antibiotics. While there is a great deal of data in adults related to bowel preparation, there is a paucity of data in children; thus, the best practices for the application of pre-operative bowel preparation in children are not established. Our goal is to determine the best practices for bowel preparation in children that undergo colon and rectal surgery. 

(Lead Centers: Cohen and University of North Carolina) 

Esophageal atresia is a congenital anomaly that affects one in 3500 live births and is often associated with an increased cancer risk. Therefore, early screening interventions are necessary to identify, treat, and prevent disease.

Our multi-phase study aims to better understand current practice and preferences in esophageal atresia surveillance while ultimately developing evidence-based practice guidelines to steer future practice.  The initial part involves a survey EPSN institutions to understand current surveillance practice as well as perspectives of surgeons and gastroenterologists. This data provides background for developing a multi-institutional database (initially retrospective) of current practice and esophageal pathology in this patient population. To in turn, then create a multi-disciplinary practice protocol to standardize care across participating EPSN institutions. Ultimately, this will generate the first multi-institutional, longitudinal prospective EA database to help generate evidence-based, practice guidelines for future surveillance practice is esophageal atresia. 

(Lead Center: University of Connecticut)