Browsing by Author "Hafezi, Niloufar"

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    Misdiagnosis of trisomy 13 and trisomy 18 is more common than anticipated
    (Wiley, 2022) Geddes, Gabrielle C.; Hafezi, Niloufar; Gray, Brian W.; Medical and Molecular Genetics, School of Medicine
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    Partial splenectomy in children: Long-term reoperative outcomes
    (Elsevier, 2021-11) Hafezi, Niloufar; Carpenter, Kyle L.; Colgate, Cameron L.; Gray, Brian W.; Rescorla, Frederick J.; Surgery, School of Medicine
    PURPOSE: Partial, or subtotal, splenectomy (PS) has become an accepted alternative to total splenectomy (TS) for management of hematologic disorders in children, but little is known about its long-term outcomes. Here, we present our institutional experience with partial splenectomy, to determine rate of subsequent TS or cholecystectomy and identify if any factors affected this need. METHODS: All patients who underwent partial splenectomy at a single tertiary children's hospital were retrospectively reviewed from 2002 through 2019 after IRB approval. Primary outcome of interest was rate of reoperation to completion splenectomy (CS) and rate of cholecystectomy. Secondary outcome were positive predictor(s) for these subsequent procedures. RESULTS: Twenty-four patients underwent PS, at median age 6.0 years, with preoperative spleen size of 12.7 cm by ultrasound. At median follow up time of 8.0 years, 29% of all patients and 24% of hereditary spherocytosis (HS) patients underwent completion splenectomy at median 34 months and 45 months, respectively. Amongst HS patients who did not have a cholecystectomy with or prior to PS, 39% underwent a delayed cholecystectomy following PS. There were no significant differences in age at index procedure, preoperative splenic volume, weight of splenic specimen removed, transfusion requirements, preoperative or postoperative hematologic parameters (including hemoglobin, hematocrit, total bilirubin, and reticulocyte count) amongst patients of all diagnoses and HS only who underwent PS alone compared to those who went on to CS. There were no cases of OPSS or deaths. CONCLUSION: Partial splenectomy is a safe alternative to total splenectomy in children with hematologic disease with theoretical decreased susceptibility to OPSS. However, families should be counseled of a 29% chance of reoperation to completion splenectomy, and, in HS patients, a 39% chance of delayed cholecystectomy if not performed prior to or with PS. Further studies are needed to understand predictors of these outcomes.
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    Pediatric Complicated Appendicitis During the COVID-19 Pandemic: A National Perspective
    (Elsevier, 2021-11) Hafezi, Niloufar; Pecoraro, Anthony; Landman, Matthew P.; Colgate, Cameron; Rescorla, Frederick J.; Pediatrics, School of Medicine
    Introduction: The COVID-19 pandemic has changed the public’s perception of safety in accessing healthcare across common surgical emergencies, including acute appendicitis in children. Here, we aim to determine whether the COVID-19 pandemic is associated with poorer appendicitis outcomes and predict that there are higher complicated appendicitis (CA) rates during this time. Methods: A retrospective cohort study was conducted in patients younger than 19 years with a new diagnosis of acute appendicitis. Rates of CA were compared in the pre- (3/1/2019-5/31/2019) and post-COVID (3/1/2020-5/31/2020) timeframes using the Pediatric Health Information System national database. The primary end point of interest was CA rates. Secondary end point of interest was hospital length of stay. A p value < 0.05 was significant. Results: Nationally, 6,212 patients had acute appendicitis pre-COVID compared with 5,372 post-COVID. The CA rate post-COVID was 33%, which was significantly higher than 30% CA rate pre-COVID, and the rate of uncomplicated appendicitis post-COVID was lower (p < 0.001). An overall increase in hospital length of stay nationally was observed for all patients treated post-COVID (p < 0.001), as well as in those with CA (p < 0.001). Conclusion: The COVID-19 pandemic is directly associated with higher disease burden in pediatric acute appendicitis. The healthcare system must understand its role in alleviating public fear in seeking healthcare for patients and their families to encourage timely medical care.
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    Survivors of Congenital Diaphragmatic Hernia Repair Face Barriers to Long-Term Follow-Up Care
    (Elsevier, 2021-11) Tragesser, Cody J.; Hafezi, Niloufar; Kitsis, Michelle; Markel, Troy A.; Gray, Brian W.; Surgery, School of Medicine
    BACKGROUND: Congenital diaphragmatic hernia (CDH) carries high morbidity and mortality, and survivors commonly have neurodevelopmental, gastrointestinal, and pulmonary sequela requiring multidisciplinary care well beyond repair. We predict that following hospitalization for repair, CDH survivors face many barriers to receiving future medical care. METHODS: A retrospective review was conducted of all living CDH patients between ages 0 to 12 years who underwent repair at Riley Hospital for Children (RHC) from 2010 through 2019. Follow-up status with specialty providers was reviewed, and all eligible families were contacted to complete a survey regarding various aspects of their child's care, including functional status, quality of life, and barriers to care. Bivariate analysis was applied to patient data (P < 0.05 was significant) and survey responses were analyzed qualitatively. RESULTS: After exclusions, 70 survivors were contacted. Thirty-three (47%) were deemed lost to follow up to specialist providers, and were similar to those who maintained follow-up with respect to defect severity type (A-D, P = 0.57), ECMO use (P = 0.35), number of affected organ systems (P = 0.36), and number of providers following after discharge (P = 0.33). Seventeen (24%) families completed the survey, of whom eight (47%) were deemed lost to follow up to specialist providers. Families reported distance and time constraints, access to CDH-specific information and care, access to CDH-specific resources, and access to healthcare as significant barriers to care. All respondents were interested in a multidisciplinary CDH clinic. CONCLUSIONS: CDH survivors require multidisciplinary care beyond initial repair, but attrition to follow-up after discharge is high. A multidisciplinary CDH clinic may address caregivers' perceived barriers.
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    Traumatic abdominal wall hernias in children: A case for early exploration
    (Elsevier, 2020) Hafezi, Niloufar; Raymond, Jodi L.; Mayo, Erin D.; Rouse, Thomas M.; Billmire, Deborah F.; Gray, Brian W.; Surgery, School of Medicine
    Purpose Traumatic abdominal wall hernia (TAWH) is a rare consequence of blunt abdominal trauma (BAT). We examined a series of patients suffering TAWH to evaluate its frequency, rate of associated concurrent intraabdominal injuries (CAI) and correlation with CT, management and outcomes. Methods A Level 1 pediatric trauma center trauma registry was queried for children less than 18 years old suffering TAWH from BAT between 2009 and 2019. Results 9370 patients were admitted after BAT. TAWH was observed in 11 children, at incidence 0.1%. Eight children (73%) were male, at mean age 10 years, and mean ISS of 16. Six cases (55%) were because of MVC, three (27%) impaled by a handlebar or pole, and two (18%) dragged under large machinery. Seven (64%) had a CAI requiring operative or interventional management. Patients with CAI were similar to those without other injury, with 20% and 50% CT scan sensitivity and specificity for detection of associated injury, respectively. Five patients had immediate hernia repair with laparotomy for repair of intraabdominal injury, three had delayed repair, two have asymptomatic unrepaired TAWH, and one resolved spontaneously. Conclusions Children with TAWH have high rates of CAI requiring operative repair. CT scans have low sensitivity and specificity for detecting associated injuries. A high suspicion of injury and low threshold for exploration must be maintained in TAWH cases.