PEDIATRIC SURGERY

CHICAGO

ACCESS

Referring physician newsletter from the University of Chicago Medicine Section of Pediatric Surgery

SUMMER 2016

UChicago Medicine: Quality Care Near Your PatientsPediatric specialists are dedicated to delivering on the UChicago promise of access to high-quality and compassionate pediatric care. To that end, we have expanded our off-site locations, so that you may refer your patients to one of our clinics:

UNIVERSITY OF CHICAGO PEDIATRIC SPECIALISTS 8528 BROADWAY MERRILLVILLE, IN 46410

UNIVERSITY OF CHICAGO SURGERY SUITE AT NORTHSHORE UNIVERSITY HEALTHSYSTEM 1000 CENTRAL STREET, SUITE 800 EVANSTON, IL 60201

THE UNIVERSITY OF CHICAGO MEDICINE AT LITTLE COMPANY OF MARY 2800 W. 95TH STREET EVERGREEN PARK, IL 60805

For referrals or urgent transfers, please call 773.702.6175.

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WELCOME TO THE LATEST ISSUE OF CHICAGO PEDIATRIC SURGERY ACCESS

Twelve hospitals, including the University of Chicago Medicine, are taking part in a multi-institution, nationally funded study to evaluate antibiotic-only treatment of uncomplicated appendicitis in children, as compared to surgical treatment. UChicago Medicine is one of only two centers in the state taking part in this study.

These investigators will compare the benefits and drawbacks of each course of care, including cost, the potential complications, and the time required for patients to resume normal activities. This study is one of the ways Dr. Mak, associate professor of surgery at UChicago Medicine, and other pediatric surgeons are trying to improve the paradigm of appendicitis care.

“In many cases, uncomplicated appendicitis does not require an emergency operation; new information suggests that there may be better, safer options,” Dr. Mak said. Rather, patients are evaluated and if they meet criteria, can begin treatment with intravenous (IV) antibiotics while the surgeons, patients and their families discuss surgical and non-surgical options.

“We want to prepare parents for these treatment options and help them to understand that new, safe and effective approaches are available. Using this approach, we can ease parents’ concerns and set appropriate expectations for their children’s care,” she said.

Studies have shown that many cases of uncomplicated adult appendicitis can be treated effectively with antibiotics alone, leading to quicker recoveries and lower costs of care. Pilot studies have shown that this may also be an option for children. Now, Grace Mak, MD, and colleagues in the Midwest Pediatric Surgical Consortium are setting out to rigorously gather data and confirm this finding in pediatric patients.

Before recommending non-operative treatment for pediatric patients, physicians will ensure that each patient meets clearly defined criteria. Parents who choose participation in the study can then elect the option of surgery or antibiotics alone for their child. Enrolling a child in the study allows physicians to collect data about the child’s course in the hospital and as an outpatient afterwards.

Children whose families have chosen IV antibiotics alone are closely monitored in the hospital for at least 24 hours. Patients who meet the criteria for response are then allowed to eat a normal diet, and transitioned to oral antibiotics. Treatment with antibiotics then continues at home after discharge. Children are monitored in the days after their initial treatment and at specified intervals via phone calls for a total of two years. This close monitoring during and after antibiotic treatment allows the treatment team to recommend a change of course if needed.

For example, if the child ceases to recover satisfactorily, the surgeon may advise the family to proceed with appendectomy.

Physicians and surgeons can help counsel patients and their families on which course of action would best fit their situation. Patients in rural areas without specialists close by might opt for surgery to quell any potential fears of recurrences. Conversely, patients who are concerned about anesthesia or surgical complications might find antibiotics to be a less stressful option.

“Both options are safe and effective,” Dr. Mak said. “Treating certain types of appendicitis with antibiotics is not an experimental option. Rather, this treatment plan may provide some patients with an alternative to surgery that allows a swifter return to normal activities and decreased operative risks. We are excited to offer the most up-to-date and leading edge therapies to our patients.”

Antibiotics Alone Effective for Uncomplicated Appendicitis Management in Children

Agenda-setting research and discovery is a critical cornerstone of our tripartite mission at the University of Chicago Medicine Comer Children’s Hospital. To that

end, our faculty in the Section of Pediatric Surgery are dedicated to improving our understanding of the most challenging diseases afflicting babies and children.

In this issue of Chicago Pediatric Surgery ACCESS, we invite you to learn more about one particular clinical trial in which our institution participates. Led by Grace Mak, MD, and colleagues at the Midwest Pediatric Surgical Consortium, we are seeking to understand the safety and efficacy of treating pediatric cases of uncomplicated appendicitis with antibiotics alone.

We are still currently recruiting for this study. If you find one of your patients may be a candidate for this clinical trial, you are welcome to reach out to schedule an appointment with Dr. Mak. For these or any other type of referral or urgent transfers, you may call 773.702.6175 at any time.

Our commitment to our colleagues first and foremost is access: we are available for any questions you may have about a patient or about one of our clinical programs. By working together, we can bring safer and higher quality care to all children in our communities.

JESSICA J. KANDEL, MD, FACSChief, Section of Pediatric Surgery

Mary Campau Ryerson Professor of Surgery

Surgeon-in-Chief, Comer Children’s Hospital

This newsletter is published by the Section of Pediatric Surgery at the University of Chicago Medicine Department of Surgery. Please direct story ideas and comments to info@surgery.bsd.uchicago.edu.

Design: Words&Pictures, Inc.

SECTION OF PEDIATRIC SURGERY SPECIALTIES & INTERESTS:

• Antenatal consultations

• Congenital malformations

• Chronic abdominal conditions

• Vascular anomalies

• Colorectal reconstructions

• Pediatric cancer, including hyperthermic intraperitoneal chemotherapy

• Esophageal reconstruction and gastroesophageal reflux

• Trauma

We know that you are interested in the latest treatments for your patients, and are eager to find new resources and options for them. This newsletter updates you on the innovative procedures and unique treatment options available right here in Chicago. Our pediatric surgeons are doing amazing things, and we want you to see how we can work together to benefit your patients.

It’s easy to refer a patient — please see back cover.

“Treating certain types of appendicitis with antibiotics is not an experimental option. Rather, this treatment plan may provide some patients with an alternative to surgery that allows a swifter return to normal activities and decreased operative risks. We are excited to offer the most up-to-date and leading edge therapies to our patients.”

– Grace Mak, MD

Children first treated with IV antibiotics will be monitored in the hospital for at least 24 hours before transitioning to oral antibiotics at home.