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Children with heart failure have few mechanical circulatory support options and have a high incidence of embolic events. The favorable hemocompatibility and smaller profile of HeartMate 3 may provide more long-term options for the pediatric population. [ABSTRACT FROM AUTHOR]

Right ventricular failure continues to be the Achilles heel in the management of heart failure patients. Traditionally, either high doses of inotropes and inhaled nitric oxide or jerry-rigged temporary mechanical devices have been used to support failing right ventricles. No durable implantable right ventricular assist device has been developed to address this long-standing concern. Because of this vacuum of innovation, surgeons have started using the third-generation LVADs to support the right ventricle. The HeartMate 3 (Abbott) LVAD is a safe and effective therapy for the management of biventricular failure. [ABSTRACT FROM AUTHOR]

We present the first case of ischemic stroke secondary to massive air embolus during implantation of a left ventricular assist device (LVAD). The patient experienced a suction event at the time of aortic cannula removal. Despite the use of all standard deairing techniques and flooding the operative field with continuous-flow carbon dioxide, a significant amount of air was delivered into the ascending aorta through the LVAD pump. [ABSTRACT FROM AUTHOR]

BACKGROUND: We sought to examine the impact of race on the management and outcomes of appendicitis in children aged 20 years or younger. METHODS: We studied 96,865 inpatient admissions for children undergoing an appendectomy for acute appendicitis in 2009 using the Kids' Inpatient Database. RESULTS: Perforation at presentation was more common among African-Americans and Hispanics than Caucasians (27.5% and 32.5%, respectively, vs 23.9%, P < .001). African-Americans were less likely to have a laparoscopic procedure (odds ratio [OR]: .839, P <.001) and more likely to experience a complication (OR: 1.753, P < .001). Hispanics were also more likely to have a complication (OR: 1.123, P = .001). African-Americans and Hispanics remained in the hospital for .73 more days than Caucasians (3.07 vs 2.34 days, P < .001). CONCLUSIONS: African-American and Hispanic children present more often with perforation. Adjusting for perforation, they were more likely to have a complication and longer hospital stays. Access to care and delayed presentations may be potential explanations. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Childhood obesity is an increasing problem in affluent societies throughout the world. We sought to identify the impact of obesity on the outcome of inflammatory bowel disease (IBD) and determine differences (if any) between ulcerative colitis (UC) and Crohn’s disease (CD). Methods: The 2009 Kids’ Inpatient Database was explored for all children (≤20years) admitted with IBD. ICD-9 codes were used to identify obesity and complications, including hemorrhage, perforation, and complex fistulas. Logistic regression analysis accounting for demographics, underlying disease, surgical procedures, and obesity was performed to identify factors associated with complication development. Data are expressed as odds ratios (OR) and a 95% confidence interval (CI). A P value of 0.05 was regarded as significant. Results: From 12,465 admissions, 164 children were obese (1.3%), with no difference between CD and UC (1.3% vs. 1.4%; P=0.60). Girls had a two-fold increase in obesity (OR: 2.06, CI: 1.48–2.86; P<0.01). Obesity had no effect on elective/emergent admission rate (OR: 0.85, CI: 0.54–1.35; P=0.49), perforation (OR: 0.76, CI: 0.13–4.46; P=0.76), hemorrhage (OR: 0.64,CI: 0.34–1.21; P=0.17), complex fistula (OR: 1.19, CI: 0.45–3.17; P=0.72), or requirement for surgery (OR: 0.80, CI: 0.48–1.31; P=0.37). While the overall clinical morbidity rate was 10.7%, obesity was not associated with the development of overall complications (OR 1.20, CI: 0.75–1.93; P=0.45) or length of stay (6.36 vs. 6.10days; P=0.61). Obesity increased the rate of central venous catheter (CVC) infections (OR: 10.98, CI: 2.50–48.20; P<0.01). Conclusions: Obesity was more prevalent in girls with IBD. While obesity did not alter disease severity, rate of surgical intervention, or hospital length of stay, it was associated with higher CVC infections. [Copyright &y& Elsevier]

Abstract: Background: Morbid obesity continues to be a significant problem within the United States, as overweight/obesity rates are nearing 33%. Bariatric surgery has had success in treating obesity in adults and is becoming a viable treatment option for obese adolescents. Methods: We studied 1615 inpatient admissions for children ≤20years of age undergoing a bariatric procedure for morbid obesity in 2009 using the Kids' Inpatient Database (KID). Patients had a principal diagnosis of obesity and a bariatric procedure listed as one of their first 5 procedures. Procedures (open gastric bypass, laparoscopic gastric bypass, sleeve gastrectomy, laparoscopic gastroplasty, and laparoscopic gastric band) and complications were defined by ICD-9 codes. Results: There were 90 open gastric bypasses, 906 laparoscopic gastric bypasses, 150 sleeve gastrectomies, 18 laparoscopic gastroplasties, and 445 laparoscopic gastric bandings. The length of stay for each procedure was 2.44, 2.20, 2.33, 1.10, and 1.02days, respectively (P <0.001). The complication rates were 3.3%, 3.5%, 0.7%, 0.0%, 0.2%, respectively (P =0.004). Conclusions: Bariatric surgery is an increasingly utilized option for the treatment of morbid obesity among adolescents. The procedures can be performed safely as evidenced by low complication rates. Additional long-term follow-up is necessary. [Copyright &y& Elsevier]

Abstract: Purpose: To examine the trends in laparoscopic appendectomy (LA) utilization and outcomes for children 5years or younger. Methods: We studied 16,028 inpatient admissions for children 5years of age or less undergoing an appendectomy for acute appendicitis in 2000, 2003, and 2006 using the Kids' Inpatient Database (KID). Laparoscopy frequency, hospital length of stay, and complications were reviewed. Results: In 2000, 2003 and 2006 appendectomies were done laparoscopically 11.4%, 18.7% and 31.3% of the time, respectively. Children were more likely to undergo LA at a children's hospital (P <0.001). LA complications were less likely overall (OR: 0.80, CI: 0.70–0.92, P =0.002) and in perforated cases (OR: 0.78, CI: 0.67-0.91, P =0.001). LA decreased hospital length of stay by 0.54days for all patients and 0.70days for perforated cases (P <0.001). Conclusions: Open appendectomy has historically been the standard in children 5years of age and younger. Laparoscopic appendectomy has slowly gained acceptance for the treatment of appendicitis in smaller children. The use of laparoscopy has increased significantly at all facilities. Furthermore, laparoscopic appendectomy in this age group has a comparatively low complication rate and short hospital length of stay, and is safe in complicated perforated appendicitis cases. [Copyright &y& Elsevier]

Abstract: Introduction: The surgeon''s clinical note has been previously shown to poorly reflect both physician-centered and patient-centered outcomes. We hypothesized that dictated operative reports do not adequately demonstrate surgeons'' workload, preoperative involvement, clinical decision-making, or core competencies. Materials and methods: We retrospectively reviewed operative reports in the month of January for the years 2007–2011. Operative reports were dictated by interns, residents (R1–R5), and surgical staff. All resident reports were approved by staff surgeons. We qualitatively assessed each for 15 items that encompassed physician-centered outcomes, patient-centered outcomes, and Joint Commission/Medicare-required fields. Groups were compared to each other with 1-way analysis of variance with Bonferroni correction. Results: We reviewed 999 operative reports. Nearly every chart included an indication and preoperative and postoperative diagnoses. Only 57.3% listed whether or not there were any complications. Half recorded operative findings. The mean number of fields missed based on level of surgical training was R1: 4.83, R2: 4.46, R3: 3.68, R4: 3.35, R5: 3.29, and staff: 3.09. Interns and second-year residents missed significantly more data fields than upper-level residents and staff (P < 0.0001). Staff surgeons missed fewer data fields than third-year residents (P = 0.004). There was no statistical difference between R4, R5, and surgical staff (P > 0.999). Conclusions: The dictated operative report does not accurately document preoperative surgeon involvement, clinical decision-making, maintenance of core competencies, or full compliance with Joint Commission regulations. Focused education and enhanced staff oversight of junior-level dictated operative reports might be required to improve quality. [Copyright &y& Elsevier]