A pitfall of using general equivalence mappings to estimate national trends of surgical utilization for pediatric patients.

ENhancing Recovery In CHildren Undergoing Surgery (ENRICH-US) Study. 

Initiated in the 1990s, perioperative Enhanced Recovery Protocols (ERPs) have progressively gained traction in a wide range of adult surgical disciplines and resulted in decreased hospital length of stay (LOS), in-hospital costs, complications, and markedly improved patient care experience that mitigates the physiologic stress of surgery and hastens recovery. However, it is estimated that it takes nearly 20 years for evidence to make its way into clinical practice, and failure rates for implementing complex innovations range from 30% to 90%.  Implementation of ERPs in pediatric surgery is lagging and concerted efforts to demonstrate both clinical effectiveness and to examine obstacles to implementation are needed. Over the past four years, our study team modified existing adult ERPs to meet the needs of pediatric patients undergoing elective GI surgery. Based on the positive results of a pilot study, we proposed the ENRICH-US Study.  The trial is designed to evaluate the effectiveness of ERPs while assessing implementation fidelity, sustainability, and site-specific adaptations. The cluster randomized trial design is ideally suited for this type of pragmatic intervention implementation.  The study was funded by the NIH/NICHD in October 2019 and is currently ongoing.

Find more information about this study here.

The ‘Implementation of Pediatric Education for Acute Pain Relief through Relaxation’ (PEACEFUL) Project.

The ‘Implementation of Pediatric Education for Acute Pain Relief through Relaxation’ (PEACEFUL) project will be the first evaluate implementation strategies and clinical outcomes of diaphragmatic breathing education in pediatric surgery. The results of this project will provide early data needed to both demonstrate clinical effectiveness of diaphragmatic breathing and inform adoption for future dissemination efforts.  

The Safety Assessment of Perioperative Pain Medications for Children (SAPPhire) Study.

Currently, no comprehensive data source exists that catalogues pediatric surgery perioperative pain management practices, including pain medication prescribing and that also assesses pain control, both of which are necessary to develop evidence-based recommendations for pediatric surgery perioperative pain management. This project, Safety Assessment of Perioperative Pain Medications for Children (SAPPhire),will create this unique data source to study, understand, and improve current pediatric surgery perioperative pain management, by combining data about current pain management practices (e.g., local anesthetics, regional nerve blocks, non-opioid analgesics, and pediatric-specific opioid prescribing practices), with patient-level demographic, health (e.g., comorbid conditions, surgical procedure), and outcomes (e.g., length of stay, surgical-site infections, and readmission) data from the American College of Surgeons (ACS) National Surgical Quality Improvement Program-Pediatric (NSQIP-P). In addition, post-discharge opioid use and patient reported outcomes (PROs) on pain control and limitations of daily activities will be collected. Combined, these data will guide feedback and interventions to address surgeon- and hospital-level pain management practice variation and identify high “opioid-use” procedures and high “opioid-exposed” subgroups of pediatric surgical patients. The study will also assess adherence to FDA opioid medication contraindications and warnings. This formative study will provide essential information needed to develop pediatric procedure- and patient-specific guidelines for pain management.