Abstract

Acute pain is an expected symptom for adolescents after outpatient surgery. In the USA, postoperative analgesic regimens frequently include prescription opioids. Increasing attention from clinicians, patients and other healthcare leaders has been directed toward non-opioid strategies, such as combining non-steroidal anti-inflammatory drugs (NSAIDs) plus acetaminophen, as potential first-line options for managing postoperative pain. However, the effectiveness and safety of home regimens that include versus exclude opioids for adolescents are unclear. The Comparing Analgesic Regimen Effectiveness and Safety after surgery for Kids study evaluates the effectiveness and safety of NSAIDs plus acetaminophen alone (NSAID regimen) versus NSAIDs and acetaminophen plus a low-dose opioid regimen (opioid regimen).This study is a pragmatic, multicentre randomised controlled clinical trial recruiting 900 patients aged 12-20 years undergoing three common outpatient surgeries (tonsillectomy, laparoscopic cholecystectomy, knee arthroscopy) across four health systems. We will recruit patients prior to surgery and individuals will be randomised 1:1 with stratification to receive prescriptions for either the NSAID regimen or the opioid regimen. The primary effectiveness outcome is patient-reported pain intensity, while the primary safety outcome is adverse medication-related symptoms both assessed over the first 2 weeks after surgery. Secondary outcomes include quality of recovery, healthcare-related quality of life and rates of problematic substance use and chronic prescription opioid use, assessed up to 1 year after surgery.The study incorporates stakeholder collaboration, including patient partners, surgeons, professional organisations., and health insurance payors, to ensure ethical conduct and relevance. This study is overseen by a single institutional review board with certificate of confidentiality. Findings will be disseminated through academic publications, conferences and community outreach to inform patients, parents, surgical teams and policymakers about optimal pain management strategies for adolescents after surgery.NCT06671002.

View details for DOI 10.1136/bmjopen-2026-118728

View details for PubMedID 42208996

Abstract

BACKGROUND: Surgical antimicrobial prophylaxis (SAP) before gastrostomy tube placement is supported by guidelines but evidence regarding its efficacy in preventing surgical site infections (SSIs) in children is conflicting and largely extrapolated from adult data. This study aims to analyze the association between SAP and postoperative outcomes in children undergoing G-Tube placement.METHODS: We conducted a retrospective multicenter cohort study using the ACS NSQIP-Pediatric database (2021-2024) to identify children undergoing gastrostomy tube insertion. Patients with contaminated/dirty wound classifications or concurrent surgeries were excluded. The primary exposure was preoperative SAP, and propensity score overlap weighting was utilized to balance covariates like race, age, and ASA classification to estimate the association between SAP and 30-day SSI, unplanned readmission, and reoperation. Associations after overlap weighting were reported as adjusted odds ratio (AOR) while baseline comparisons were done using Wilcoxon rank sum test, Chi-squared test and Fisher's exact test as appropriate. A p value of less than 0.05 was considered significant.RESULTS: A total of 14,109 patients were included (mean age 2.7 ± 4.0 years), of whom 13,408 (95.0%) received SAP and 701 (5.0%) did not. Cefazolin was the most common agent (94.7%). White (8,246, 58%) was the most common race, though significant baseline differences existed in race/ethnicity between the SAP and no-SAP groups (p < 0.001). Unadjusted 30-day SSI rates were 4.7% for the SAP group and 4.4% for the no-SAP group (p = 0.8). In the weighted analysis, SAP was not associated with a reduction in SSIs (AOR 1.01, 95% CI 0.69-1.46), unplanned readmissions (AOR 0.93, 95% CI 0.70-1.22), or reoperations (AOR 0.78; 95% CI 0.48-1.27). Sub-analysis stratified by risk profile further confirmed no statistically significant benefit from prophylaxis in reducing infectious complications.CONCLUSIONS: Routine surgical antibiotic prophylaxis appears not to be associated with improved short-term outcomes or reduced infection rates following pediatric gastrostomy tube placement. These findings support reevaluation of institutional protocols to potentially reduce unnecessary antibiotic exposure without compromising patient safety.

View details for DOI 10.1016/j.jpedsurg.2026.163152

View details for PubMedID 41999972

Abstract

Post operative sepsis in neonates is a serious problem that may be challenging to diagnose. It is standard practice at our Neonatal Intensive Care Unit (NICU) in Pakistan to perform routine Blood Cultures (BLCS) and C-Reactive Protein (CRP) to screen for post-operative sepsis. We aimed to review this practice to investigate its effectiveness at screening for post-operative sepsis.All neonates admitted to the NICU post-operatively at our center from 2017-2022 were included. Relevant clinical and demographic data were collected. The sensitivity of BLCS was calculated for each post-operative day (POD) and an ROC curve was constructed for overall CRP values to quantify their screening value.A total of 109 post-operative neonates were included (median gestational age 37 weeks, birth weight 2.4kg). Thirteen (12.6%) developed sepsis. Only two patients had pathological microbe growth on POD 0 or 1, both having growth preoperatively. BLCS sensitivity increased significantly after POD 2. CRP performed poorly at discriminating post-operative sepsis (AUROC=0.55).Routine BLCS performed immediately after surgery did not predict the onset of post-operative sepsis. CRP performed poorly at discriminating post-operative sepsis, likely due to physiologic inflammation in post-operative neonates. Unnecessary screening tests represent a significant financial burden in LMICs, with little clear clinical benefit.

View details for DOI 10.12669/pjms.42.(11AASC).15734

View details for PubMedID 42136778

View details for PubMedCentralID PMC13169989

Abstract

Adjuvant steroids in the treatment of BA remains controversial. We sought to characterize variations in steroid use and their effect on postoperative outcomes in a multi-institutional cohort of BA patients.PHIS was queried for all patients between 2017 and 2024 who were diagnosed with BA and underwent KPE. Patients who received ≥ 3 contiguous days of steroids within 7 days of KPE were considered to have received postoperative steroids. The primary outcome was native liver survival, calculated using Kaplan-Meier analysis.504 patients from 37 hospitals with a median age of 52 days (IQR: 35-69 days) met inclusion criteria. 139 patients (28.6%) received adjuvant steroids. The steroid-treated cohort had a significantly longer postoperative LOS (P < 0.001) and high-volume-KPE hospitals were significantly more likely to use adjuvant steroids (P < 0.001). The majority of patients were started on steroids on POD#0. 5 hospitals utilized steroids in > 50% of their patients after KPE. Kaplan-Meier analysis showed no difference in two-year native liver survival.In this large multi-institutional cohort study, steroids were used early, with significant intra-hospital variation, and were associated with increased postoperative LOS and higher KPE volume. Larger multi-institutional studies with standardized steroid dosage regimens and extended long-term follow up are needed.III.

View details for DOI 10.1007/s00383-026-06401-x

View details for PubMedID 41865321

View details for PubMedCentralID 4303045

Abstract

The incidence of pediatric gallstone disease continues to rise, largely driven by increasing obesity rates. Laparoscopic cholecystectomy (LC) has been the standard surgical approach, with robotic-assisted cholecystectomy (RAC) utilized less frequently. This study aimed to evaluate the implementation of RAC and its outcomes compared to LC at a single institution.A retrospective cohort study was conducted of all pediatric cholecystectomies at our children's hospital from 2017 through 2024. Surgical outcomes were abstracted. Statistical tests were employed, with p<0.05 considered significant.During the study, 420 cholecystectomies were performed: 196 LC and 224 RAC. Median age was 15.5 years, median BMI was 28.1 kg/m2, and 75% of patients were female. The most common diagnoses were choledocholithiasis (179) and symptomatic cholelithiasis (135). Yearly cholecystectomies increased. LC was performed more often for urgent cases (p<0.01). RAC was used more often in patients with obesity and severe obesity (p=0.01). Median operative time slightly differed between LC and RAC (11 minutes; p<0.01). There was one conversion to open (LC) and nine retained common duct stones. There was no difference in emergency department revisits (7.7% LC vs 6.7% RAC; p=0.69) or readmissions (2.6% LC vs 3.1% RAC; p=0.73). There were no bile leaks, common bile duct injuries or mortalities.In this largest reported cohort of pediatric RAC, RAC was found to be safe and effective compared with LC, particularly in pediatric patients with obesity. RAC can be integrated into practice without compromising patient safety. Further research evaluating educational and fiscal aspects of RAC is ongoing.

View details for DOI 10.1016/j.jpedsurg.2026.163029

View details for PubMedID 41722679

Abstract

Pull-through procedures remain the mainstay of treatment for Hirschsprung disease (HD). While laparoscopic-assisted procedures are widely performed, robotic-assisted Soave pull-through (RSPT) has emerged as a minimally invasive alternative with potential technical advantages. We systematically reviewed the available literature to evaluate the perioperative and functional outcomes of RSPT. PubMed, Embase, Scopus, Cochrane CENTRAL, and ClinicalTrials.gov were systematically searched through February 2025. Eligible studies included pediatric (< 18 years) patients undergoing RSPT. Data were pooled using random-effects models with two heterogeneity estimators to ensure robustness given the small number of included studies. Heterogeneity was assessed using I2 and τ² statistics. Primary outcomes included operative time, console time, intraoperative blood loss, and length of stay (LOS). Secondary outcomes included constipation, enterocolitis, and soiling. Study quality was assessed using the National Institutes of Health (NIH) Quality Assessment Tool. Six retrospective studies comprising 282 patients were included. Pooled mean operative and console times were 192.2 min (95% CI: 95.2-388.0) and 105.6 min (95% CI: 34.7-321.5), respectively. Mean intraoperative blood loss was 9.8 mL (95% CI: 1.9-49.4), and pooled postoperative LOS was 6.5 days (95% CI: 4.6-9.1). No difference in estimates was observed by estimator models. Postoperative complications were typically mild, manageable conservatively, and improved over time. RSPT appears to be a feasible minimally invasive option for HD, demonstrating low blood loss, short hospital stay, and acceptable functional outcomes, albeit with longer operative times which reflect logistical rather than technical inefficiency. Future adequately powered, higher quality, multicenter trials with standardized outcomes are needed to better define its role relative to established laparoscopic approaches.

View details for DOI 10.1007/s11701-026-03170-6

View details for PubMedID 41639487

View details for PubMedCentralID 7066788

View details for DOI 10.1007/s44186-025-00447-6

View details for Web of Science ID 001668923100006

Abstract

Antibiotic resistance is a major public health concern. While surgical antibiotic prophylaxis (SAP) reduces surgical site infections (SSIs), inappropriate use may cause harm. This study evaluates the impact of SAP appropriateness and compares beta-lactam versus non-beta-lactam antibiotic use in pediatric surgery.A retrospective cohort analysis was conducted using ACS NSQIP Pediatric data (2021-2023). Exclusions included preexisting infections, malignancy, immunodeficiencies, and emergent surgeries. SAP appropriateness was classified according to NSQIP guidelines. Logistic regression assessed association between SAP categories and postoperative infections, presented as odds ratios (ORs) and 95% confidence intervals (CIs).Of 189,111 patients, 87.5% received SAP, 10.2% were overtreated, and 3.9% undertreated. SSIs occurred in 1.9%. Compared to appropriate use, undertreatment was associated with higher odds of SSI (OR: 1.4; 95% CI: 1.2-1.7), sepsis (1.6; 1.1-2.2), C. difficile colitis (2.5; 1.2-5.5), and UTI (1.8; 1.2-2.5). Overtreatment was linked to lower odds of UTI (0.7; 0.5-0.8). Non-beta-lactam antibiotics had higher odds of pneumonia (1.4; 1.0-2.0; p = 0.047) compared to beta-lactam antibiotics.Appropriate SAP is crucial in minimizing postoperative infections. These results underscore the importance of antibiotic selection among pediatric surgical patients.

View details for DOI 10.1007/s00383-025-06292-4

View details for PubMedID 41521361

View details for PubMedCentralID 8225033