Ensuring Best Practices in Pediatric Surgery
Date: December 4, 2012
With so much focus today on improving patient safety and quality of care, more physicians are studying the clinical outcomes of surgical procedures. Such research is especially important for pediatric populations, as children often require treatments different from those used in adults, even for the same medical conditions.
Fizan Abdullah, a pediatric surgeon at The Johns Hopkins Hospital, has experienced this firsthand. He recalls a pediatric patient who developed an abscess following an appendectomy, which was performed at another hospital by a surgeon who did not regularly treat children. When the doctor who performed the initial surgery recommended taking the patient back into the operating room for a second operation, the child’s parents realized something wasn’t right.
After seeking a second opinion from Abdullah, they learned that the suggested surgery—while appropriate enough for adult patients—would be unnecessary and risky for a child, and that a prolonged course of antibiotics would be more appropriate. The entire situation could have been avoided, Abdullah says, if specific best-practice guidelines had been in place for dealing with pediatric appendectomy patients, which is also an advantage of being treated at a center that specializes in children.
As a pediatric surgeon, Abdullah says his practice spans an array of clinical conditions across different organ systems—one day he might see a child in need of endocrine surgery and the next day evaluate a patient with appendicitis. It’s this very variety in his clinical practice that provides Abdullah with unique advantages to broadly study surgery in children. “Much of my research,” he says, “focuses on outcomes related to the care of these children, how they do after different types surgery and how we can minimize complications and maximize safety.”
Often, he continues, that might involve studying a specific disease or condition. Some of his recent research includes examining outcomes in appendectomy patients.
In children, Abdullah says, appendectomy is the most common abdominal condition to require an emergency operation. But the techniques and clinical practices that are used often vary from doctor to doctor and practice to practice—even within the same hospital. For instance, surgeons may use different instruments to divide the blood supply of the appendix or even use entirely different approaches, such laparoscopic versus open surgery. After surgery, some of these patients wind up needing antibiotics or drainage procedures for infected wounds. But without any guidelines dictating best practices, it’s difficult for surgeons to know which treatments are the safest and lead to the best outcomes.
To that end, Abdullah and his colleagues are studying outcomes in appendectomy patients by examining a variety of factors, including the number of children who experienced a ruptured appendix, possibly caused by a delayed diagnosis, surgery, or how quickly they received antibiotics. (Some physicians, Abdullah explains, may not be as experienced at diagnosing pediatric appendicitis, while others have different preferences about how long to wait before surgery or how to use antibiotics.)
“Any time you’re treating a disease, if you have clinical practice guidelines in place, you can reduce costs and improve the quality of care,” Abdullah says. “The hope is that we can develop guidelines for treatment that can be used by hospitals everywhere.”