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Jonathan E Kohler - One of the best experts on this subject based on the ideXlab platform.
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age dependent costs and complications in pediatric Umbilical Hernia repair
The Journal of Pediatrics, 2020Co-Authors: Jonathan E Kohler, Randi Cartmill, Douyan Yang, Sara Fernandestaylor, Caprice C GreenbergAbstract:Objectives To characterize regional variation in the age of patients undergoing Umbilical Hernia repair to determine costs and subsequent care. Study design We performed a cross-sectional descriptive study using a large convenience sample of US employer-based insurance claims from July 2012 to December 2015. We identified children younger than 18 years of age undergoing uncomplicated (not strangulated, incarcerated, or gangrenous) Umbilical Hernia repair as an isolated procedure (International Classification of Diseases, Ninth Revision procedure codes 53.41, 53.42, 53.43, or 53.49, International Classification of Diseases, Tenth Revision procedure code 0WQF0ZZ, or Current Procedural Terminology procedure codes 49580 or 49585). Results In all, 5212 children met criteria for inclusion. Children younger than age 2 years accounted for 9.7% of repairs, with significant variation by census region (6% to 14%, P Conclusions Umbilical Hernias continue to be repaired at early ages with large regional variation. Umbilical Hernia repair younger than age 2 years is associated with greater costs and greater frequency of postoperative hospitalization and emergency department visits.
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age dependent costs and complications in pediatric Umbilical Hernia repair
The Journal of Pediatrics, 2020Co-Authors: Jonathan E Kohler, Randi Cartmill, Douyan Yang, Sara Fernandestaylor, Caprice C GreenbergAbstract:OBJECTIVES To characterize regional variation in the age of patients undergoing Umbilical Hernia repair to determine costs and subsequent care. STUDY DESIGN We performed a cross-sectional descriptive study using a large convenience sample of US employer-based insurance claims from July 2012 to December 2015. We identified children younger than 18 years of age undergoing uncomplicated (not strangulated, incarcerated, or gangrenous) Umbilical Hernia repair as an isolated procedure (International Classification of Diseases, Ninth Revision procedure codes 53.41, 53.42, 53.43, or 53.49, International Classification of Diseases, Tenth Revision procedure code 0WQF0ZZ, or Current Procedural Terminology procedure codes 49580 or 49585). RESULTS In all, 5212 children met criteria for inclusion. Children younger than age 2 years accounted for 9.7% of repairs, with significant variation by census region (6% to 14%, P < .001). Total payments for surgery varied by age; children younger than 2 years averaged $8219 and payments for older children were $6137. Postoperative admissions occurred at a rate of 73.1 per 1000 for children younger than age 2 years and 7.43 for older children; emergency department visits were 41.5 per 1000 for children younger than age 2 years vs 15.9 for older children (P < .001). CONCLUSIONS Umbilical Hernias continue to be repaired at early ages with large regional variation. Umbilical Hernia repair younger than age 2 years is associated with greater costs and greater frequency of postoperative hospitalization and emergency department visits.
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national variation in opioid prescribing after pediatric Umbilical Hernia repair
Surgery, 2019Co-Authors: Randi Cartmill, Douyan Yang, Sara Fernandestaylor, Jonathan E KohlerAbstract:Background Pediatric Umbilical Hernia repair is a common procedure that requires minimal tissue disruption. We examined variation in opioid prescription fills after repair of uncomplicated Umbilical Hernias to characterize the types and doses of medication used and persistent postsurgical use. Methods Using the Truven Health Analytics MarketScan© Research Database for June 2012–September 2015, we identified pediatric patients undergoing Umbilical Hernia repair. We excluded patients with obstruction, gangrene, an earlier repair or a concurrent surgical procedure, and those without available pharmacy claim data. Analyses describe filled outpatient prescriptions by age, geographic region, drug type, quantity, and second prescriptions/refills. Results Of 4,407 procedures performed, 2,292 patients (52%) filled a prescription for postoperative opioids (age 0–1 years: 21.6%, age 2–3 years: 51.5%, age 4–5 years: 54.3%, 6 years or older: 57.9% [P 10 days (4%). A total of 6% of patients filled a second opioid prescription within 30 days. Conclusion Although many patients do not require opioids for Umbilical Hernia repair, most pediatric patients fill opioid prescriptions, including for prolonged courses and refills. Guidelines for appropriate prescribing of opioids after common, simple procedures, such as Umbilical Hernia repair, could improve the quality of care for children and impact the US epidemic of opioid abuse.
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age dependent outcomes in asymptomatic Umbilical Hernia repair
Pediatric Surgery International, 2019Co-Authors: Tiffany J. Zens, Randi Cartmill, Bridget L. Muldowney, Peter F Nichol, Andrew P Rogers, Daniel J Ostlie, Jonathan E KohlerAbstract:Umbilical Hernias are common in young children. Many resolve spontaneously by age four with very low risk of symptoms or incarceration. Complications associated with surgical repair of asymptomatic Umbilical Hernias have not been well elucidated. We analyzed data from one hospital to test the hypothesis that repair at younger ages is associated with increased complication rates. A retrospective chart review of all Umbilical Hernia repairs performed during 2007–2015 was conducted at a tertiary care children’s hospital. Patients undergoing repairs as a single procedure for asymptomatic Hernia were evaluated for post-operative complications by age, demographics, and co-morbidities. Of 308 Umbilical Hernia repairs performed, 204 were isolated and asymptomatic. Postoperative complications were more frequent in children 4 years (3.1%, p = 0.034). All respiratory complications (N = 4) and readmissions (N = 1) were in children < 4 years. Age of Umbilical Hernia repair in children varied widely even within a single institution, demonstrating that timing of repair may be a surgeon-dependent decision. Patients < 4 years were more likely to experience post-operative complications. Umbilical Hernias often resolve over time and can safely be monitored with watchful waiting. Formal guidelines are needed to support delayed repair and prevent unnecessary, potentially harmful operations.
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practice variation in Umbilical Hernia repair demonstrates a need for best practice guidelines
The Journal of Pediatrics, 2019Co-Authors: Tiffany J. Zens, Randi Cartmill, Sara Fernandestaylor, Bridget L. Muldowney, Peter F Nichol, Jonathan E KohlerAbstract:Objective To evaluate and better understand variations in practice patterns, we analyzed ambulatory surgery claims data from 3 demographically diverse states to assess the relationship between age at Umbilical Hernia repair and patient, hospital, and geographic characteristics. Study design We performed a cross-sectional descriptive study of uncomplicated Hernia repairs performed as a single procedure in 2012-2014, using the State Ambulatory Surgery and Services Database for Wisconsin, New York, and Florida. Age and demographic characteristics of Umbilical Hernia repair patients are described. Results The State Ambulatory Surgery and Services Database analysis included 6551 patients. Across 3 states, 8.2% of Hernia repairs were performed in children Conclusions The age of pediatric Umbilical Hernia repair varies widely. As Hernias may resolve over time and can be safely monitored with watchful waiting, formal guidelines are needed to support delayed repair and prevent unnecessary operations.
Sarah Tracy - One of the best experts on this subject based on the ideXlab platform.
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ultrasonography guided bilateral rectus sheath block vs local anesthetic infiltration after pediatric Umbilical Hernia repair a prospective randomized clinical trial
JAMA Surgery, 2013Co-Authors: Scott R Dingeman, Lindsay M Barus, Hyun Kee Chung, David J Clendenin, Christopher S Lee, Sarah TracyAbstract:Importance Regional anesthetic techniques can be used to alleviate postoperative pain in children undergoing pediatric surgical procedures. Use of ultrasonographic guidance for bilateral rectus sheath block (BRSB) has been shown to improve immediate pain scores and reduce use of postoperative analgesia in the postanesthesia care unit (PACU). Objective To compare efficacy of ultrasonography-guided BRSB and local anesthetic infiltration (LAI) in providing postoperative analgesia after pediatric Umbilical Hernia repair. Design Prospective, observer-blinded, randomized clinical trial. Setting Tertiary-referral urban children’s hospital. Participants Eligible children 3 to 12 years of age undergoing elective Umbilical Hernia repair from November 16, 2009, through May 31, 2011. Interventions Ropivacaine hydrochloride administered at the conclusion of surgery as LAI by the surgeon (n = 25) or as ultrasonography-guided BRSB by the anesthesiologist (n = 27). Main Outcomes and Measures Scores on the FACES Pain Rating Scale measured at 10-minute intervals and all use of analgesic medications in the PACU. Results Median FACES scores in the PACU were lower in the BRSB group compared with the LAI group at 10 minutes (0 vs 1; P = .04), 30 minutes (0 vs 1; P = .01), and 40 minutes or later (0 vs 1; P = .03). Fewer doses of opioid and nonopioid medications were given to the BRSB group compared with the LAI group (5 vs 11 doses for opioids; 5 vs 10 for nonopioids). Conclusions and Relevance In the PACU, ultrasonography-guided BRSB after Umbilical Hernia repair in children is associated with lower median FACES scores and decreased use of opioid and nonopioid medications compared with LAI. Future studies could examine the use of longer-acting anesthetic agents with ultrasonography-guided BRSB. Trial Registration clinicaltrials.gov Identifier:NCT01015053
Thomas M Austin - One of the best experts on this subject based on the ideXlab platform.
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ultrasound guided bilateral rectus sheath block with and without dexmedetomidine in pediatric Umbilical Hernia repairs a retrospective interrupted time series analysis
Regional Anesthesia and Pain Medicine, 2020Co-Authors: Cheryl J Hartzell, Justin B Long, William M White, Daniel Machado, Thomas M AustinAbstract:Bilateral rectus sheath block (RSB) is frequently used to provide analgesia following Umbilical Hernia repair in pediatrics.[1][1] Dexmedetomidine use in pediatric truncal nerve blocks has increased despite limited evidence of its efficacy and safety,[2][2] with no studies evaluating its effect in
Mihaela Visoiu - One of the best experts on this subject based on the ideXlab platform.
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re ultrasound guided bilateral rectus sheath block with and without dexmedetomidine in pediatric Umbilical Hernia repairs a retrospective interrupted time series analysis
Regional Anesthesia and Pain Medicine, 2020Co-Authors: Mihaela VisoiuAbstract:To the Editor After carefully reading the report by Hartzell and colleagues[1][1] on the use of dexmedetomidine for rectus sheath blockade in pediatric Umbilical Hernia repair, I have a few comments regarding the clinical significance of this study. The authors reported a statistically significant
Scott R Dingeman - One of the best experts on this subject based on the ideXlab platform.
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ultrasonography guided bilateral rectus sheath block vs local anesthetic infiltration after pediatric Umbilical Hernia repair a prospective randomized clinical trial
JAMA Surgery, 2013Co-Authors: Scott R Dingeman, Lindsay M Barus, Hyun Kee Chung, David J Clendenin, Christopher S Lee, Sarah TracyAbstract:Importance Regional anesthetic techniques can be used to alleviate postoperative pain in children undergoing pediatric surgical procedures. Use of ultrasonographic guidance for bilateral rectus sheath block (BRSB) has been shown to improve immediate pain scores and reduce use of postoperative analgesia in the postanesthesia care unit (PACU). Objective To compare efficacy of ultrasonography-guided BRSB and local anesthetic infiltration (LAI) in providing postoperative analgesia after pediatric Umbilical Hernia repair. Design Prospective, observer-blinded, randomized clinical trial. Setting Tertiary-referral urban children’s hospital. Participants Eligible children 3 to 12 years of age undergoing elective Umbilical Hernia repair from November 16, 2009, through May 31, 2011. Interventions Ropivacaine hydrochloride administered at the conclusion of surgery as LAI by the surgeon (n = 25) or as ultrasonography-guided BRSB by the anesthesiologist (n = 27). Main Outcomes and Measures Scores on the FACES Pain Rating Scale measured at 10-minute intervals and all use of analgesic medications in the PACU. Results Median FACES scores in the PACU were lower in the BRSB group compared with the LAI group at 10 minutes (0 vs 1; P = .04), 30 minutes (0 vs 1; P = .01), and 40 minutes or later (0 vs 1; P = .03). Fewer doses of opioid and nonopioid medications were given to the BRSB group compared with the LAI group (5 vs 11 doses for opioids; 5 vs 10 for nonopioids). Conclusions and Relevance In the PACU, ultrasonography-guided BRSB after Umbilical Hernia repair in children is associated with lower median FACES scores and decreased use of opioid and nonopioid medications compared with LAI. Future studies could examine the use of longer-acting anesthetic agents with ultrasonography-guided BRSB. Trial Registration clinicaltrials.gov Identifier:NCT01015053
