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Multi-disciplinary care in patients with complex pediatric general and thoracic surgical pathology: lessons learned
Benjamin A Keller1, Nicholas C Saenz2
1Division of Pediatric Surgery, Department of Surgery, Rady Children's Hospital, University of California San Diego, 3030 Children's Way Medical Office Building 1st Floor South, San Diego, CA, 92123, USA. bakeller@health.ucsd.edu.
Insights
Coordinated care for complex pediatric surgical cases involving thoracic or infradiaphragmatic tumors is crucial. A multidisciplinary approach significantly improves patient safety and outcomes, with zero mortality in this study.
Area of Science:
- Pediatric Surgery
- Surgical Oncology
- Thoracic Surgery
Background:
- Complex pediatric surgical cases with thoracic or infradiaphragmatic tumors pose risks.
- Lack of coordinated care can lead to increased morbidity and mortality.
- Identifying key management strategies is essential for improving patient outcomes.
Purpose of the Study:
- To identify critical areas for managing pediatric patients with complex thoracic and infradiaphragmatic tumors.
- To improve the care and outcomes for these high-risk surgical patients.
Main Methods:
- A 20-year retrospective study analyzed pediatric patients with complex surgical pathology.
- Data collected included demographics, pre-operative, intraoperative, and outcomes data.
- Three index cases were highlighted for detailed management review.
Main Results:
- Twenty-six patients with conditions like mediastinal teratomas and advanced Wilms tumors were identified.
- All cases involved a multidisciplinary approach, including pediatric cardiothoracic surgery.
- Zero operative and 30-day mortality was observed, with 30.7% requiring cardiopulmonary bypass.
Conclusions:
- A multidisciplinary team approach is vital for managing complex pediatric surgical patients.
- Pre-operative planning and customized care plans enhance patient safety.
- This coordinated strategy leads to excellent patient outcomes.
Purpose:
Complex pediatric surgery patients with thoracic tumors invading the mediastinum and infradiaphragmatic tumors extending into the chest are at risk for surgical morbidity and mortality if the patient's care is not coordinated. We sought to identify areas of focus when managing these patients to improve care.
Methods:
A 20-year, retrospective study of pediatric patients with complex surgical pathology was performed. Demographic data, pre-operative characteristics, intraoperative data, complications, and outcomes data were collected. Three index cases were highlighted to provide granularity in patient management.
Results:
Twenty-six patients were identified. Common pathology included mediastinal teratomas, foregut duplications, advanced Wilms tumors, hepatoblastoma, and lung masses. All cases were performed in a multidisciplinary fashion. All cases were done with pediatric cardiothoracic surgery and three cases (11.5%) required pediatric otolaryngology. Eight patients (30.7%) required cardiopulmonary bypass. Operative and 30-day mortality was zero.
Conclusions:
Management of complex pediatric surgical patients requires a multidisciplinary approach throughout the patient's hospital course. This multidisciplinary team should meet in advance of a patient's procedure to create a customized care plan that may include pre-operative optimization. At the time of their procedure, all necessary and emergency equipment should available. This approach improves patient safety and has resulted in excellent outcomes.
Level Of Evidence:
IV.
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