Fluid Management in Critically Ill Children: Single-Center Retrospective Comparison of Trauma and Postoperative Patients, 2020-2022.

OBJECTIVE: Injury and surgery both represent well-defined starting points of a predictable inflammatory response, but the consequent response to IV fluids has not been studied. We aimed to review and compare our single-center fluid management strategies in these two populations. DESIGN: Retrospective cohort study from January 2020 to July 2022. The primary outcome was total IV fluid volume administered. Net fluid balances and select clinical outcomes were also evaluated. SETTING: Single tertiary academic center and level 1 pediatric trauma center in New York. PATIENTS: A dataset of critically ill trauma and surgical patients aged 0-18 years who were admitted to the PICU, 2020-2022. Trauma patients had at least moderate traumatic injuries (Injury Severity Score ≥ 9) and surgical patients had at least a 1-hour operation time. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We identified 25 trauma and 115 surgical patients. During the first 5 days of hospitalization, we did not identify an association between grouping and total IV fluids administered and fluid balance in the prehospital, emergency department, and operating room (p = 0.90 and p = 0.79), even when adjusted for weight (p = 0.96). Time trend graphs of net fluid balance and IV fluid administered illustrated analogous fluid requirement and response with the transition from net positive to net negative fluid balance between 48 and 72 hours. There was an association between total IV fluid and ventilator requirement (p = 0.003). CONCLUSIONS: Critically ill pediatric trauma and postoperative patients seem to have similar fluid management and balance after injury or surgery. In our opinion, these two critically ill populations could be combined in large prospective studies on optimal fluid therapy in critically ill children.

Enhanced recovery after surgery improves clinical outcomes in adolescent bariatric surgery.

BACKGROUND: Enhanced recovery after surgery (ERAS) protocols are evidence-based, multimodal approaches to optimize patient recovery and minimize complications. OBJECTIVES: Our team evaluated clinical outcomes following the implementation of an ERAS protocol for adolescents undergoing metabolic and bariatric surgery. SETTING: Academic hospital, New York, NY, USA. METHODS: We performed a single-institution longitudinal assessment of adolescents who underwent laparoscopic vertical sleeve gastrectomy (VSG) between August 2021 and November 2022. Unpaired t-tests and Fisher's exact test were used to compare means between groups and categorical factors. RESULTS: Forty-three patients were included in the study, 21 who participated in the ERAS protocol and 22 control patients. ERAS cohort was 52% females, with a median age of 17.5 years and a median body mass index (BMI) of 46.3 kg/m2. The non-ERAS cohort was 59% females, with a median age of 16.7 years and a median BMI of 44.0 kg/m2. There were no significant differences between baseline characteristics. Patients in the ERAS group had a shorter time to oral intake (10.7 hours versus 21.5 hours, P < .01), lower morphine milligram equivalents (18.2 versus 97.0, P < .01), and shorter length of stay (1.5 days versus 2.0 days, P = .01). There were no significant differences between return visits to the emergency department (ED) within 30 days (3 versus 2, P = .66) or readmissions (0 versus 1, P = 1.0). CONCLUSIONS: The described ERAS protocol is safe and effective in adolescents undergoing laparoscopic VSG and is associated with shorter time to oral intake, reduced opioid requirements, and shorter hospital lengths of stay with no increase in return ED visits or readmissions.

Letters of recommendation for surgical fellowships - Does gender make a difference?

BACKGROUND: Females comprise 1/3 of general surgery residents, 1/4 of surgical faculty and 10% of full professors. Inadequate sponsorship is one proposed mechanism for this decline. This study evaluated letters of recommendation (LOR) among applicants applying to a complex general surgical oncology (CGSO) fellowship. METHODS: Linguistic analysis of LOR for CGSO applicants was conducted. Demographics of authors and features of the LOR were extracted. Differences by gender of the applicant were analyzed. RESULTS: Among 340 letters, 67% were written for male and 33% written for female applicants. Males authored 84% of letters reviewed. Female authors used more grindstone adjectives than males (3.61 v 2.90). However, this difference was seen only among letters written for male applicants (3.82 v. 2.73). All other linguistic features were similar, aside from mention of physical appearance which was significantly more common in letters written about female applicants (4% v. 1%). CONCLUSIONS: Female authors write substantively different letters than males. Physical appearance is a small but important difference in letters for female applicants.

The impact of body mass index on severity of cervical spine fracture: A retrospective cohort study.

BACKGROUND: No study has evaluated the relationship between increasing BMI and severity/type of cervical spine injuries. AIMS AND OBJECTIVES: The objective of our study was to study the impact of body mass index (BMI) on severity of cervical spine fracture. METHODS: We performed a retrospective cohort study of patients with traumatic cervical spine fractures at a level I trauma center over a 74-year period. CT scans of the cervical spine were blindly graded according to the AO Spine sub-axial cervical spine classification. The association between BMI and severity of cervical spine fracture was studied by multiple-variable logistic regression. RESULTS: A total of 291 patients with an average BMI of 26.1 ± 5.4 kg/m2 were studied. Higher BMI was not associated with more severe injury (OR 1.03, 95%, CI: 0.97-1.08). For rollover motor vehicle accident (MVA), the association was trending towards significance (OR 2.55, 95%, CI: 0.98-6.66, P = 0.06). CONCLUSIONS: Patients with higher BMI may be predisposed to more severe cervical spine fracture in rollover MVA, but not non-rollover MVA or falls.