Routine Overnight Assessments in Stable Pediatric Surgery Patients: A Critical Reconsideration

Background: Hospitalized patients are subject to overnight vital sign (OVS) monitoring which leads to subsequent sleep disturbance and contributes to adverse outcomes and negative hospital experiences. Studies in pediatric populations have shown that routine OVS checks infrequently detect significant events. We hypothesized that OVS monitoring in pediatric surgery patients rarely detects abnormalities resulting in meaningful interventions. Materials and methods: We performed a retrospective chart review of patients ≥ 5 years old admitted to the pediatric surgery service at a stand-alone Children\u27s Hospital from 2019 to 2021. ICU patients were excluded from analysis. Overnight vital signs were defined as those recorded every 4 h between 10:00 PM and 6:00 AM. Abnormal OVS and subsequent interventions were recorded. Results: Analysis included 354 patients aged 5-19 years old. At least one OVS was abnormal in 62% of patients. Abnormal blood pressure was the most commonly flagged OVS (80%). The rate of intervention for flagged OVS was 58%. Medication administration was the most common intervention (54%). Unplanned operative intervention and transfer to the ICU were uncommon but did occur in this cohort (0.9% and 1.4%, respectively). Conclusion: The majority of pediatric surgery patients had at least one flagged OVS and, while rare, some serious complications were detected. While minimizing sleep disturbance and maximizing patient satisfaction is valuable, these results support prioritizing patient safety with routine vital sign assessments until we can determine if there are sub-populations that can be safely managed without sleep disruptions. Level of evidence: Level 4. Study type: Retrospective chart review

Puestow Procedure for the Management of Pediatric Chronic Pancreatitis

Objective Recurrent pancreatitis significantly impacts childhood development and quality of life. Our goal was to evaluate the efficacy of the Puestow procedure. Materials and Methods After obtaining the Institutional Review Board approval, we reviewed the charts of all patients who underwent lateral pancreaticojejunostomy from January 1999 to January 2014. Statistical analysis was performed using paired Student's t-test and Fisher's exact test as appropriate. Results During the 15-year study period, 13 patients underwent a lateral pancreaticojejunostomy for chronic pancreatitis. The most common causes of pancreatitis were hereditary (n = 5) or obstructive (n = 5); pancreas divisum (n = 2), one iatrogenic stricture, one idiopathic stricture, and one unresectable pancreatic head mass); two patients had idiopathic disease, and one case was drug-induced. Six patients had failed management with endoscopic retrograde cholangiopancreatography and pancreatic duct stenting. Preoperatively, the median body mass index (BMI) percentile-for-age was 61.0% (range 11.0–99.0%). Median age at operation was 12.8 years (range 7.7–16.7). There were no deaths, four patients developed postoperative ileus, and one patient developed an intra-abdominal abscess, which resolved with antibiotics. Median postoperative length of stay was 7 days (range 5–15).Two patients were lost to follow-up; median follow-up for the remaining 12 patients was 35.5 months (range 4.9–131.2). Four patients were readmitted within 90 days: three due to abdominal pain which were not recurrences of pancreatitis, and one due to complications of chemotherapy. Postoperatively, there was no change in the average BMI percentile-for-age (p = 0.64). Seven patients reported resolution or significant improvement in their abdominal pain symptoms at the time of last follow-up. Patients with obstructive causes of pancreatitis were not more likely to experience relief than those with nonobstructive causes (42.9 vs. 80.0%, p = 0.29). Conclusion In our experience, lateral pancreaticojejunostomy results in durable improvement or resolution of abdominal pain symptoms in nearly 60% of patients with chronic pancreatitis regardless of etiology.</jats:p