David Grabski, MD - Best of the Best in Pediatric Surgery 2024

The intervention was based on IV Tylenol, directed post-operative pain education seminars for related faculty and staff, and standardized post-surgical sign out.

The study included 250 children under 1 year old who underwent non-emergent abdominal surgery in either the NICU or the acute care floor.

The intervention reduced post-operative opiate use by 98% in the study population.

In the pre-intervention cohort, the median postoperative morphine equivalence for Black children was 13 mg per kilogram, while for White children it was 2 mg per kilogram, and for Hispanic children it was 3.5 mg per kilogram.

Black children received a sixfold increase in post-operative opiate use compared to their White peers in the pre-intervention cohort.

In the post-intervention cohort, the median postoperative morphine equivalence in Black children reduced to just above 0 mg per kilogram, while for White children it was 0.05 mg per kilogram, and for Hispanic children it was 0.1 mg per kilogram, with these findings being statistically equivalent.

There was no statistical difference in demographic or clinical variables in the pre-intervention or post-intervention cohort when analyzed by race.

The type of surgery performed in each cohort was proportionally equivalent by race.

There was no difference in postoperative pain scores in any racial group.

The median total length of stay for Black children in the pre-intervention cohort was 45 days, while for White children it was 16 days.

Following the intervention, the total length of stay for Black children was 8 days, which was identical to White children.

A racial disparity was found in the pre-intervention cohort in length of post-operative intubation and TPN usage, both of which were eliminated following the clinical protocol.

Preliminary data suggests there might be a disparity in regional anesthesia use.

Standardization at all levels (pre-surgery, surgery, post-surgery, and throughout the NICU phase) was critical to the work.

Socioeconomic status associated with race was likely significant in the disparity.

Parents at bedside help with consoling and driving care, and that level of presence in the NICU was probably important.

At UVA during the study and at Lurie Children's currently, PRNs are often delivered by bedside nurses.

At UVA, the NAS pain score was used and if it reached a threshold, a PRN (usually fentanyl) was delivered.