Whether children are under the steady hand of surgeon and anesthesiologist, or medical and research trainees are under the guidance of an experienced mentor, knowledge makes all the difference. This much is clear from the top stories in our weekly roundup of research news at The Children’s Hospital of Philadelphia.
This week, we bring you two issues that relate to surgery safety for children. One is a study showing disparities in outcomes between black and white patients, an important piece of knowledge to recognize to drive improvements in care, while the other is a perspective on concerns about safety of anesthesia for young surgery patients, an area where knowledge is just beginning to emerge. In addition, this week we congratulate a CHOP expert for her recognition with the first-ever mentoring award in her discipline’s professional society. Read on for more.
Racial Disparities in Pediatric Urologic Surgery
Surgery often means the difference between improved health and continued suffering, if not between life and death. But research has shown that outcomes from surgery can vary not just based on medical risk factors, but based on social or demographic differences between groups — with members of racial minorities and lower-income populations seeing worse outcomes from certain types of surgeries, based on studies done primarily in adults. The issue is significant and concerning enough that, this spring, the National Institutes of Health launched an initiative to support research to better understand and address disparities in surgical care and outcomes for disadvantaged populations.
“While racial disparities in surgical outcomes have been reported in adult health care, less is known about possible disparities in pediatric surgery,” said David Chu, MD, a fellow in Pediatric Urology at CHOP who was first author of a new study published last week in Pediatrics. “The health disparities we found in children's surgery likely have complex causes, which warrant further investigation.”
With colleagues Gregory Tasian, MD, MSc, MSCE, and Douglas Canning, MD, both pediatric urologists at CHOP and faculty members at the Perelman School of Medicine at the University of Pennsylvania, Dr. Chu analyzed data from nearly 12,000 patients who underwent pediatric urology procedures in a national registry of surgical cases from more than 50 pediatric hospitals.
Overall, the study team found that non-Hispanic black children had significantly higher odds of overall complications (odds ratio 1.34) and of hospital-acquired infection (odds ratio 1.54) than non-Hispanic white children after 30 days. These significant associations were independent of baseline health conditions, type of surgery and other factors. They described additional differences in complication risks between different types of surgeries.
One possible explanation for the racial disparities, the authors suggest, is that black patients may be more likely than white patients to be treated at hospitals with fewer resources. Dr. Chu noted that further research is needed, both to systematically investigate potential causes of these disparities, and to design care processes and other medical interventions to reduce those disparities.
Read more in the CHOP press release.
Added Perspective on Anesthesia Safety for Children
Even when a child’s surgery is successful and uncomplicated, parents may wonder about the safety of anesthesia exposure and its potential later effects on brain development. Earlier this month, we brought you news of CHOP anesthesiologists’ contribution to a JAMA study demonstrating the long-term safety of a single dose of general anesthesia in young children who were otherwise healthy.
Writing for Philly.com this week, Ronald Litman, DO, an attending anesthesiologist at CHOP and professor of Anesthesiology and Critical Care Medicine and Pediatrics at Penn, added context and perspective on the finding, including discussion of a study addressing similar questions that was published in The Lancet earlier this year.
“Although encouraging, these recent studies do not tell the complete story,” Dr. Litman wrote. “For example, we do not yet know if multiple exposures to general anesthetics result in subsequent harm, nor do we know whether some anesthetics are safer than others. But, keep in mind, that a child only receives general anesthesia because they need a medical procedure that wouldn’t be possible while they are awake.”
Dr. Litman concludes that despite such unknowns, the importance of a needed medical procedure for a child ‘s overall health should outweigh most concerns about avoiding general anesthesia.
Read more in the Philly.com post.
Mentoring Excellence Award for Elaine Zackai
This week, the American Society of Human Genetics (ASHG) announced that Elaine Zackai, MD, director of clinical genetics at CHOP and professor of Pediatrics and Obstetrics and Gynecology at Penn, will be the first-ever recipient of its Mentorship Award.
“Dr. Zackai's nomination included testimonials from 38 former trainees who now occupy research and clinical positions at institutions around the world,” said Raju Kucherlapati, PhD, chair of the ASHG Awards Committee in an ASHG press release. “Their comments credited her dedication to her students, leadership by example, compassion for patients, and rigorous approach to diagnosis with inspiring them to successful careers in human genetics.”
The award presentation will take place during ASHG's 66th Annual Meeting in Vancouver, British Columbia, in October.
Congratulations to Dr. Zackai!
Stories We’re Following
Here is a quick preview of some stories we will cover in more depth on Cornerstone and/or in Bench to Bedside in the near future:
A team at CHOP led by Susan Levy, MD, and including Alex Fiks, MD, MSCE, found that pediatricians and parents are not communicating as much about treatment decisions for autism spectrum disorder as they ideally should to achieve a goal of shared decision-making. Read more in a CHOP press release and look for a follow-up story soon.
And this week, CHOP hosted the Coalition Against Childhood Cancer (CAC2) Annual Summit. The meeting brought together members of numerous philanthropic foundations focused on pediatric cancer advocacy, family support, and research, for two days of educational programming from nationally prominent speakers from CHOP and elsewhere. Catch up on tweets from the meeting with hashtag #CAC2 (including our own tweets on @CHOP_Research). We’ll have a story about it in the coming weeks.
In case you missed it, earlier this week on Cornerstone we brought you a Q&A with an investigator who builds miniature computer models of the hospital to predict and improve upon systemic changes; and the news of CHOP’s continued outstanding performance in children’s hospital rankings by U.S. News & World Report.
Last week’s In the News post covered new recommendations for children’s sleep, a remarkable discovery of lymphatic disease and its treatment, findings on the benefit of physical activity on children predisposed to fragile bones, and a new military-family support role for a CHOP policy researcher.
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