Empirical research guiding pediatric surgical practice has historically been limited not only by the rarity of major diseases, such as pediatric cancers and congenital anomalies, but also by the absence of data on social determinants of health that contextualize children’s outcomes. The rapid growth of health information technology and data-sharing capabilities has created unprecedented opportunities to integrate clinical and social dimensions of care, expand our understanding of rare pediatric surgical diseases, and optimize equitable care through understanding of how biological and structural factors intersect to influence outcomes and access.
Our laboratory leverages these advances to study severe illnesses such as esophageal atresia, congenital diaphragmatic hernia, abdominal wall defects, congenital lung malformations, and other complex birth defects and tumors. We aim to understand not only their clinical outcomes but also how these are shaped by social determinants of health, including race, household income, and health-related social needs such as food insecurity and housing instability.
By harnessing “big data” and fostering national and international partnerships, our laboratory seeks to address long-standing and often contentious questions in pediatric surgery while illuminating the social and systemic factors that influence care. Our work focuses on three broad domains of pediatric surgical research:
- Improving surgical management protocols to enhance patient outcomes and standardize best practices.
- Identifying low-value or potentially harmful care to reduce unnecessary interventions and optimize resource use.
- Advancing global surgical equity by examining the intersection of social determinants and health systems, and addressing barriers that prevent equal access to safe, high-quality surgical care worldwide.
Through these efforts, and in close collaboration with our collaborators, we aim to define pathways toward more equitable, data-driven, and patient-centered surgical care for all children.
Research Director
Dr. Faraz Khan
Mission Statement
To advance the quality, safety, and accessibility of pediatric surgical care worldwide through data-driven research, innovation in clinical practice, and global collaboration.
Goals
- Develop evidence-based, data-driven clinical benchmarks to standardize surgical care delivery.
- Design and implement targeted quality improvement initiatives.
- Build global partnerships to expand equitable access to surgical care.
Research Team
Anam Ehsan, MBBS
Anam is a postdoctoral research fellow within the Division of Pediatric Surgery at Stanford University.
She completed her medical education at the Aga Khan University in Pakistan, followed by research fellowships in global surgery and health services research at Harvard Medical School and Brigham and Women’s Hospital. Anam joined Dr. Khan’s lab in 2025, where she leads national and international projects at the intersection of pediatric surgery, data science, and health equity. She helped establish one of the first multicenter prospective studies on financial toxicity in surgical care in India and serves as a research and value-based healthcare advisor to the Global Surgery Foundation. Her current research focuses on integrating social determinants of health into pediatric surgical outcomes and building collaborative data systems that link clinical, social, and economic factors to improve child health worldwide.
Humza Thobani, MBBS
Humza is a postdoctoral research fellow within the Division of Pediatric Surgery at Stanford.
He completed his medical education at the Aga Khan University in Pakistan, followed by a one-year research fellowship in pediatric surgery. Humza joined Dr. Khan’s lab at Stanford in 2024 and has since spearheaded several of the lab’s completed and ongoing projects. He developed an interest in health data science early in medical school, where he helped design one of the first billing code-based data registries in Pakistan. In Dr. Khan’s lab, his work focuses on utilizing national electronic health record (EHR) based data repositories to create evidence-based care pathways for neonatal surgical diseases.
Daniel Tahan, BS
Daniel is a medical student at Tulane University School of Medicine and a visiting researcher in the Division of Pediatric Surgery at Stanford University.
He completed his undergraduate degree in Economics before beginning medical training. At Tulane, he co-founded the Deep South’s first student-run clinic for refugee and MENA communities and participates in the DeBakey Scholars Program. He first joined Dr. Khan’s lab as a summer intern, investigating congenital lung malformations in children, and returned in 2025 to continue his research. His current work explores the continuum from prenatal diagnosis of CLMs to their long-term postnatal outcomes.
Bilal Iqbal, MBBS
Bilal is a visiting instructor in the Department of Pediatric Surgery at Stanford.
He earned his medical degree at the Aga Khan University and subsequently pursued a research fellowship focused in aortic and structural interventions, and the public health burden of cardiac disease. He subsequently pursued a clinical internship at his alma mater. Bilal joined the lab in 2025, where his research will focus on building databases and predictive models to study outcomes in congenital anomalies and rare diseases; leveraging artificial intelligence and machine learning in process. His prior work has also contributed to literature in this realm.
Administrative Team
Samrawit Gebregziabher
samrawit@stanford.edu
(650)724-1721
Publications
MS3 surgery curriculum evaluation Committee member, Loma Linda University (2019 - 2023)
Pediatric Surgery liaison for the ACS National Surgical Quality Improvement Program(ACS NSQIP-p), Loma Linda University (2021 - 2023)
Director of Pediatric Surgical Critical Care, Lucile Packard Children's Hospital (2023 - Present)
Publications
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Assessing the Value of Overnight Admission After Pediatric Laparoscopic Cholecystectomy: A Nationwide Propensity-Matched Analysis.
Journal of pediatric surgery
2025: 162870
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Abstract
In an era of constrained healthcare resources, optimizing postoperative care without compromising safety has become a national priority. Laparoscopic cholecystectomy (LC) is among the most common pediatric procedures, yet discharge practices vary widely. Whether overnight admission offers meaningful benefit over same-day discharge remains uncertain.Children (<18 years) undergoing LC from 2017-2023 were identified in the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P) participant use file. Patients were classified by discharge timing (same-day vs overnight). Propensity score matching (1:1) balanced demographic, clinical, and operative factors. The primary outcome was 30-day unplanned readmission; secondary outcomes included reintervention and postoperative complications.Among 15,809 patients, 11,969 (76%) were discharged the same day. After matching (n = 1,725/group), same-day discharge was associated with lower odds of unplanned readmission (aOR 0.56, 95% CI 0.38-0.80) and reintervention (aOR 0.16, 95% CI 0.05-0.41). Absolute event rates were lower for readmissions (2.7% vs 4.7%, p=0.002) and reinterventions (0.2% vs 1.4%, p<0.001) in the same-day group. Notably, 96% of readmissions occurred after 24 hours and were for transient postoperative concerns unlikely to be prevented by inpatient observation. In an exploratory analysis of 2023 cases, opioid prescription at discharge was independently associated with increased readmission risk (aOR 1.97, 95% CI 1.00-3.78).Same-day discharge after pediatric LC is common, safe, and resource-efficient. Overnight admission adds minimal safety benefit while consuming limited inpatient capacity. These findings support broader adoption of standardized same-day discharge pathways to promote responsible resource stewardship in pediatric surgical care.Retrospective Cohort Study LEVEL OF EVIDENCE: III.
View details for DOI 10.1016/j.jpedsurg.2025.162870
View details for PubMedID 41397633
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Outcomes of Sutureless versus Sutured Closure for Gastroschisis: A Systematic Review and Meta-Analysis.
Journal of pediatric surgery
2025: 162867
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Abstract
Sutureless closure is a minimally invasive alternative to traditional sutured repair for gastroschisis, yet, uncertainty persists regarding its safety and outcomes. This systematic review and meta-analysis aimed to compare treatment outcomes of sutured and sutureless gastroschisis closure.We searched the PubMed, Embase, Scopus, and ClinicalTrials.gov repositories for studies comparing outcomes of sutureless versus sutured gastroschisis closure from inception to June 2025. Outcome included mortality, feeding milestones, anesthesia outcomes, hernia outcomes, hospital stay, and postoperative complications. A random-effects model was applied and meta-regression was also conducted.Twenty-three studies (2,646 infants; 821 sutureless, 1,825 sutured) were included. Sutureless repair did not increase mortality risk [Risk ratio (RR)=1.11; 95% CI=0.61, 2.03), or delay feeding milestones [time to full feeds mean difference (MD)=-1.62 days; 95%=CI: -4.61, 1.38], although regional analyses favored faster feeding with sutureless repair (p < 0.01). Sutureless closure was associated with significantly reduced utilization of general anesthesia (RR=0.23; 95% CI=0.15, 0.36; p < 0.00001), shortened ventilation duration (MD=-1.96 days; 95% CI=-2.66, -1.26; p < 0.01), and reduced surgical site infection risk (RR=0.60; 95% CI=0.43, 0.83; p = 0.003). However, umbilical hernia incidence (RR=2.50; 95% CI=1.57, 3.98) and hernia repair (RR=2.66; 95% CI=1.65, 4.27) were higher following sutureless closure. Hospital stay showed no overall difference, and sutureless repair did not increase the risk for postoperative complications. Meta-regression identified regional practices, sex distribution, and case mix as key modifiers, highlighting the influence of center-level practices and the observational nature of the data.Sutureless closure offers substantial perioperative advantages but carries a higher umbilical hernia risk. However, these findings arise predominantly from observational studies and may be influenced by confounding by indication and institutional practice patterns. While the overall evidence supports sutureless closure as a safe approach, structured follow-up and family counseling are warranted.
View details for DOI 10.1016/j.jpedsurg.2025.162867
View details for PubMedID 41391653
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Gastrojejunostomy tubes are safe in patients ≤10kg.
Journal of pediatric gastroenterology and nutrition
2025
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View details for DOI 10.1002/jpn3.70277
View details for PubMedID 41251012
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Association of Institutional Case Volume and Children's Surgery Verification with Morbidity/Mortality in Neonatal Duodenal Atresia Repair: A Multi-institutional Cohort Study.
Journal of pediatric surgery
2025: 162770
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Abstract
BACKGROUND: Duodenal atresia (DA) is a congenital malformation of the gastrointestinal tract requiring surgical repair in the neonatal period. This study aims to evaluate the impact of both institutional case volume and American College of Surgeons (ACS) Children's Surgery Verification (CSV) status on surgical outcomes of DA repair.METHODS: This retrospective multicenter cohort study analyzed neonates (0-28 days) undergoing DA repair using ACS National Surgical Quality Improvement Program-Pediatric data from January 2016 to December 2022. The effects of relative institutional volume tertiles and CSV status on composite morbidity/mortality was assessed via hierarchical multivariate modeling with mixed effects.RESULTS: In the study period 863 neonates underwent DA repair across 135 institutions. Composite morbidity/mortality occurred in 83 (9.7%) patients; DA surgical morbidity occurred in 130 (15.1%) patients. In multivariate analysis institutional volume tertiles did not significantly affect composite morbidity/mortality. In contrast, operations performed at non-CSV-verified hospitals had significantly higher odds of composite morbidity/mortality (OR: 2.62, 95% CI: 1.39, 4.91).CONCLUSIONS: In this multi-center retrospective study, CSV status was associated with improved outcomes in neonatal DA repairs while institutional volume was not. Further research should elucidate the elements of verification which most contribute to these improved outcomes.
View details for DOI 10.1016/j.jpedsurg.2025.162770
View details for PubMedID 41192786
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Outcomes of Pouch Creation in 2-Stage Versus 3-Stage Procedures for Pediatric Ulcerative Colitis: A Propensity Score Matched Comparative Analysis.
Inflammatory bowel diseases
2025
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Abstract
Staged proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the standard surgical treatment for medically refractory pediatric ulcerative colitis (UC). This study aimed to compare the surgical outcomes of 2-stage and 3-stage IPAA in children of similar disease severity.We queried the NSQIP-Pediatric database (2016-2023) to identify patients under 18 years with UC undergoing IPAA. Patients undergoing IPAA with concurrent colectomy were classified as having a 2-stage procedure, while those undergoing IPAA alone, following a prior colectomy, were classified as having a 3-stage procedure. The primary outcome was a composite of major complications within 30 days, including mortality, organ/space infection, progressive renal insufficiency, systemic sepsis, and intra-abdominal reoperation. The treatment groups were matched using 1:1 propensity score matching to adjust for baseline differences in disease severity.A total of 479 patients met the inclusion criteria (330 underwent 3-stage and 149 underwent 2-stage procedures). The proportion of patients undergoing each approach remained stable over the study period (P = .693). At the time of pouch creation, the 2-stage group had significantly higher rates of steroid use (22.8% vs 14.5%), leukocytosis (21.9% vs 7.1%), and hypoalbuminemia (mean 4.0 vs 4.2 g/dL). After matching, 137 patient pairs were included. There was no significant difference in major complication rates between groups (OR, 1.38; 95% CI, 0.63-3.09).This study demonstrated that surgical outcomes following pouch creation were similar in a matched cohort of children undergoing 2- or 3-stage IPAA, supporting the use of a 2-stage approach in certain patients with limited disease.
View details for DOI 10.1093/ibd/izaf241
View details for PubMedID 41128337
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Pediatric Surgery and Healthcare Quality: Historical Exemplars of Quality Improvement and the Seven Basic Tools of Quality.
Journal of pediatric surgery
2025: 162718
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Abstract
LEVEL OF EVIDENCE: V.
View details for DOI 10.1016/j.jpedsurg.2025.162718
View details for PubMedID 41047115
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Pediatric inguinal hernia: open versus laparoscopic approaches to surgical management.
Current opinion in pediatrics
2025; 37 (5): 482-487
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Abstract
Inguinal hernia repair remains one of the most common pediatric surgical procedures. Advances in minimally invasive techniques have made laparoscopic herniorrhaphy a safe alternative to open surgery. This review summarizes clinical outcomes in open and laparoscopic pediatric inguinal hernia repair, discusses technical considerations including anesthetic choice, and reviews patient and surgical factors relevant to surgical approach and timing.Clinical outcomes appear similar in open and laparoscopic pediatric hernia repairs. Open surgery can be performed under regional or general anesthesia and permits direct visualization of the spermatic cord (in men) and high ligation of the hernia sac. The laparoscopic approach requires general anesthesia but permits same-setting visualization of the contralateral inguinal ring and repair of any contralateral hernia. Both techniques effectively manage recurrent hernias. Premature infants undergoing herniorrhaphy after neonatal ICU (NICU) discharge had fewer adverse events and shorter hospital stays than those undergoing surgery while in the NICU.Both laparoscopic and open pediatric inguinal hernia repairs are generally well tolerated and effective. Surgeons should be skilled in both approaches and knowledgeable about patient characteristics, anesthetic considerations, and anatomic factors that may favor one approach over another.
View details for DOI 10.1097/MOP.0000000000001498
View details for PubMedID 40904247
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Antibiotic Prophylaxis for Gastrointestinal Surgery Among Neonates and Very Young Infants: National Patterns, Outcomes, and Opportunities for Precision Stewardship.
The Journal of pediatrics
2025: 114839
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Abstract
To evaluate nationwide adherence to surgical antibiotic prophylaxis (SAP) guidelines and the association with outcomes following gastrointestinal surgeries among neonates and infants.We queried the National Surgical Quality Improvement Program-Pediatric for all patients age <90 days undergoing gastrointestinal surgery between 2021-2023. Procedures were further subcategorized by anatomic site. SAP regimens were classified as being "adherent," "undercoverage," or "overcoverage" per established guidelines and expert consensus. The primary outcome was surgical site infection (SSI). Associations between SAP classification and SSI rates for each procedure subcategory were analyzed, with further subset analyses to delineate the effects of common SAP regimens on postoperative outcomes.A total of 11,062 cases met criteria, with an overall SAP adherence of 87.2%. Rates of overcoverage (2.8%-55.5%) and undercoverage (2.8%-28.3%) varied widely by procedure type. SAP undercoverage did not increase the odds of SSI for most procedures analyzed, with the exception of patients undergoing colorectal procedures, in whom cefazolin monotherapy (undercoverage) was associated with higher odds of SSI (OR=2.17, 95% CI=1.08-4.18). Broadening SAP coverage (overcoverage) and prolonging SAP duration were not associated with reduced SSI rates for any subcategory of procedure.Adherence to empiric SAP guidelines has been applied poorly to neonates and very young infants undergoing gastrointestinal surgery. There appears to be limited benefit to broadening SAP coverage for surgery in this patient population. These findings underscore the need for increased adherence to recommendations driven by neonatal-specific data , aiming to balance optimized post-operative outcomes with antimicrobial stewardship goals.
View details for DOI 10.1016/j.jpeds.2025.114839
View details for PubMedID 41016460
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Outcomes of a Second Run of Extracorporeal Membrane Oxygenation in Neonates: A Propensity Score Matched Analysis of a Nationwide Registry.
ASAIO journal (American Society for Artificial Internal Organs : 1992)
2025
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Abstract
This study analyzed the outcomes of neonates undergoing a second run of extracorporeal membrane oxygenation (ECMO) to determine whether there is a benefit to a repeated run. We used Extracorporeal Life Support Organization data to compare neonates undergoing a single versus two runs of ECMO from 2009 to 2019. Baseline characteristics of single-run patients were compared with the first run in two-run patients to identify clinical predictors of a second run of ECMO. Furthermore, we compared overall survival outcomes and ECMO-related complications in single-run and two-run patients, with propensity score matching to adjust for baseline differences between the groups. A total of 12,292 patients undergoing 12,668 ECMO runs met criteria. Neonates requiring a second run had a shorter duration of the first ECMO run (p < 0.001) and were more likely to have had venoarterial cannulation (p < 0.001) than single-run patients. Overall, 33.8% of patients undergoing a second run survived until discharge, compared with 62.9% of patients undergoing a single run only. Propensity score matched analysis demonstrated that patients undergoing two runs were more likely to die, irrespective of underlying physiologic status or ECMO indication (odds ratio [OR] = 3.53, 95% confidence interval [CI] = 2.75-4.56). Nevertheless, nearly a third of patients undergoing two ECMO runs survived until discharge, indicating that recannulation may be beneficial in certain patient cohorts.
View details for DOI 10.1097/MAT.0000000000002546
View details for PubMedID 40923597
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Antibiotic Stewardship in Pediatric Complicated Appendicitis: Assessing the Role of Oral Antibiotics after Discharge.
Journal of pediatric surgery
2025: 162594
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Abstract
To determine whether home oral antibiotic (OA) use after appendectomy for pediatric complicated appendicitis reduces post-discharge complications in children who are afebrile prior to discharge.We queried the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) dataset for children aged 1-18 years who underwent appendectomy for complicated appendicitis between 2019-2023. Patients were included if they were afebrile and had no infective complications (i.e. fever, surgical site infections etc.) at discharge. All patients were stratified into age groups (ages 1-5, 5-10 and 10-18) and were subsequently grouped by whether they were prescribed home OA. The primary outcome measure was post-discharge intra-abdominal abscess (IAA). The relationship between home OA use and post-discharge outcomes was analyzed using multivariable logistic regression.A total of 20,190 patients met criteria, with a median age of 10.0 years (IQR: 6.9-13.1). Approximately 70.9% of patients received home OA and 29.1% did not. Patient characteristics including age, preoperative WBC count, operative time, and length of stay appeared similar at baseline on unadjusted analysis. On multivariable analysis, home OA use did not reduce the odds of IAA in any age group (Age 1-5: aOR=1.27, 95% CI=0.80-2.09; Age 5-10: aOR=1.15, 95% CI=0.90-1.50; Age 10-18: aOR=1.05, 95% CI=0.86-1.30). A subset analysis conducted for patients aged 5-18 years with intraoperative findings of perforated appendicitis also failed to identify any association between home OA use and post-discharge IAA (aOR=1.09, 95% C.I.=0.92-1.29).There appears to be limited benefit to prescribing home OA for children with complicated appendicitis who are afebrile after appendectomy.Retrospective Cohort Study LEVEL OF EVIDENCE: Level III evidence.
View details for DOI 10.1016/j.jpedsurg.2025.162594
View details for PubMedID 40845978