{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T12:46:59Z","timestamp":1790858819016,"version":"4.1.0"},"reference-count":25,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,2,1]]},"abstract":"<jats:sec>\n                  <jats:title\/>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>BACKGROUND AND OBJECTIVES<\/jats:title>\n                  <jats:p>Many patients receiving pediatric palliative care (PPC) present with surgically treatable problems. The role of surgery in the care of these patients, however, has not yet been defined. We conducted a cohort study of children receiving PPC to assess the incidence, type, and likely purpose of surgical interventions performed after the initiation of PPC.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>We performed a cohort analysis of surgical interventions performed on children enrolled in an ongoing, multicenter, prospective cohort study. Patients aged &amp;lt;30 years receiving PPC services were eligible for inclusion in the study. Analyses included descriptive and comparative statistics, as well as logistic regression models.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>After initiation of PPC, 81.1% (n = 488) of patients had undergone at least 1 surgical intervention (range, 1\u201371) with a median of 4 interventions (interquartile range, 1\u20139). The most frequent surgical interventions were feeding tubes, endoscopic biopsy, tracheostomy, bone marrow biopsy, tunneled catheters, bronchoscopy, and chest tube placement, followed by sternum closure, abdominal closure, atrial and ventricular septal defect repairs, and heart transplantation. Children who underwent surgical interventions were statistically less likely to die while receiving PPC (29% vs 40%, P &amp;lt; .03).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Most children receiving PPC services undergo at least 1 surgical intervention, and many undergo numerous interventions. Undergoing intervention is not futile because surgical intervention is associated with longer survival. Various patient populations that are more likely, as well as less likely, to undergo surgical intervention warrant specific focus.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/peds.2022-058905","type":"journal-article","created":{"date-parts":[[2023,1,6]],"date-time":"2023-01-06T08:24:14Z","timestamp":1672993454000},"source":"Crossref","is-referenced-by-count":13,"title":["Surgical Intervention in Patients Receiving Pediatric Palliative Care Services"],"prefix":"10.1542","volume":"151","author":[{"given":"Danielle I.","family":"Ellis","sequence":"first","affiliation":[{"name":"aDepartment of Surgery, Massachusetts General Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russell T.","family":"Nye","sequence":"additional","affiliation":[{"name":"bData Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne","family":"Wolfe","sequence":"additional","affiliation":[{"name":"cDepartment of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute"},{"name":"dDepartment of Medicine, Boston Children\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Feudtner","sequence":"additional","affiliation":[{"name":"bData Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"},{"name":"ePediatric Advanced Care Team and Department of Medical Ethics, Children\u2019s Hospital of Philadelphia, the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2023,1,6]]},"reference":[{"issue":"6","key":"2023111013555416300_B1","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1542\/peds.2013-1286","article-title":"Pediatric palliative care programs in children\u2019s hospitals: a cross-sectional national survey","volume":"132","author":"Feudtner","year":"2013","journal-title":"Pediatrics"},{"issue":"8","key":"2023111013555416300_B2","doi-asserted-by":"crossref","first-page":"e2119730","DOI":"10.1001\/jamanetworkopen.2021.19730","article-title":"Polysymptomatology in pediatric patients receiving palliative care based on parent-reported data","volume":"4","author":"Feudtner","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"9","key":"2023111013555416300_B3","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1089\/jpm.2013.0014","article-title":"Did increased availability of pediatric palliative care lead to improved palliative care outcomes in children with cancer?","volume":"16","author":"Schmidt","year":"2013","journal-title":"J Palliat Med"},{"issue":"10","key":"2023111013555416300_B4","doi-asserted-by":"crossref","first-page":"1717","DOI":"10.1200\/JCO.2007.14.0277","article-title":"Easing of suffering in children with cancer at the end of life: is care changing?","volume":"26","author":"Wolfe","year":"2008","journal-title":"J Clin Oncol"},{"issue":"8","key":"2023111013555416300_B5","doi-asserted-by":"crossref","first-page":"1409","DOI":"10.1002\/pbc.25530","article-title":"Differences in end-of-life communication for children with advanced cancer who were referred to a palliative care team","volume":"62","author":"Kassam","year":"2015","journal-title":"Pediatr Blood Cancer"},{"issue":"2 Pt 1","key":"2023111013555416300_B6","first-page":"351","article-title":"Committee on Bioethics and Committee on Hospital Care. Palliative care for children","volume":"106","author":"American Academy of Pediatrics","year":"2000","journal-title":"Pediatrics"},{"issue":"8","key":"2023111013555416300_B7","doi-asserted-by":"crossref","first-page":"e27817","DOI":"10.1002\/pbc.27817","article-title":"Palliative care: a surgical perspective","volume":"66","author":"Inserra","year":"2019","journal-title":"Pediatr Blood Cancer"},{"issue":"6","key":"2023111013555416300_B8","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1542\/peds.2010-3225","article-title":"Pediatric palliative care patients: a prospective multicenter cohort study","volume":"127","author":"Feudtner","year":"2011","journal-title":"Pediatrics"},{"issue":"4","key":"2023111013555416300_B9","doi-asserted-by":"crossref","first-page":"326","DOI":"10.21037\/tp.2018.09.11","article-title":"Pediatric palliative care in the intensive care unit and questions of quality: a review of the determinants and mechanisms of high-quality palliative care in the pediatric intensive care unit (PICU)","volume":"7","author":"Short","year":"2018","journal-title":"Transl Pediatr"},{"issue":"3","key":"2023111013555416300_B10","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/j.cnc.2015.05.005","article-title":"Pediatric palliative care in the intensive care unit","volume":"27","author":"Madden","year":"2015","journal-title":"Crit Care Nurs Clin North Am"},{"issue":"3","key":"2023111013555416300_B11","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1353\/pbm.2018.0008","article-title":"Futility, inappropriateness, conflict, and the complexity of medical decision-making","volume":"60","author":"Feudtner","year":"2018","journal-title":"Perspect Biol Med"},{"key":"2023111013555416300_B12","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.jss.2020.05.046","article-title":"Parental understanding of surgical care in the neonatal intensive care unit","volume":"255","author":"Wright","year":"2020","journal-title":"J Surg Res"},{"issue":"5","key":"2023111013555416300_B13","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1053\/j.sempedsurg.2014.09.002","article-title":"Prenatal counselling and the role of the paediatric surgeon","volume":"23","author":"Benachi","year":"2014","journal-title":"Semin Pediatr Surg"},{"issue":"2","key":"2023111013555416300_B14","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1016\/j.suc.2011.01.004","article-title":"Palliative care and pediatric surgery","volume":"91","author":"Shelton","year":"2011","journal-title":"Surg Clin North Am"},{"issue":"5","key":"2023111013555416300_B15","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1016\/j.jpedsurg.2018.02.038","article-title":"Interventions in the operating room for children near end of life: a multidisciplinary approach","volume":"53","author":"Goudreault","year":"2018","journal-title":"J Pediatr Surg"},{"issue":"6","key":"2023111013555416300_B16","doi-asserted-by":"crossref","first-page":"e2020047464","DOI":"10.1542\/peds.2020-047464","article-title":"Surgical interventions during end-of-life hospitalizations in children\u2019s hospitals","volume":"148","author":"Traynor","year":"2021","journal-title":"Pediatrics"},{"key":"2023111013555416300_B17","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1186\/1471-2431-14-199","article-title":"Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation","volume":"14","author":"Feudtner","year":"2014","journal-title":"BMC Pediatr"},{"issue":"7","key":"2023111013555416300_B18","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1089\/jpm.2017.0079","article-title":"Palliative care in surgery: defining the research priorities","volume":"20","author":"Lilley","year":"2017","journal-title":"J Palliat Med"},{"issue":"5","key":"2023111013555416300_B19","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1542\/peds.2015-0260","article-title":"Hospital use in the last year of life for children with life-threatening complex chronic conditions","volume":"136","author":"Ananth","year":"2015","journal-title":"Pediatrics"},{"issue":"1","key":"2023111013555416300_B20","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.jtcvs.2004.04.002","article-title":"Gender differences in pediatric cardiac surgery: the surgeon\u2019s perspective","volume":"128","author":"Azakie","year":"2004","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"3","key":"2023111013555416300_B21","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1001\/jamasurg.2020.6257","article-title":"Racial disparities in the use of surgical procedures in the US","volume":"156","author":"Best","year":"2021","journal-title":"JAMA Surg"},{"issue":"2","key":"2023111013555416300_B22","doi-asserted-by":"crossref","first-page":"e20194113","DOI":"10.1542\/peds.2019-4113","article-title":"Race, postoperative complications, and death in apparently healthy children","volume":"146","author":"Nafiu","year":"2020","journal-title":"Pediatrics"},{"issue":"2","key":"2023111013555416300_B23","doi-asserted-by":"crossref","first-page":"871","DOI":"10.21037\/apm-20-2046","article-title":"Palliative care education in surgery","volume":"11","author":"Jafri","year":"2022","journal-title":"Ann Palliat Med"},{"issue":"2","key":"2023111013555416300_B24","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1089\/jpm.2018.0420","article-title":"Indicators used to assess the impact of specialized pediatric palliative care: a scoping review","volume":"22","author":"Widger","year":"2019","journal-title":"J Palliat Med"},{"key":"2023111013555416300_B25","unstructured":"Frey\n              WH\n            . Brookings. Less than half of US children under 15 are white, census shows. Available at: https:\/\/www.brookings.edu\/research\/less-than-half-of-us-children-under-15-are-white-census-shows\/. Accessed November 3, 2022"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2022-058905\/1564815\/peds_2022058905.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2022-058905\/1564815\/peds_2022058905.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,10]],"date-time":"2023-11-10T13:57:23Z","timestamp":1699624643000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/151\/2\/e2022058905\/190437\/Surgical-Intervention-in-Patients-Receiving"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,6]]},"references-count":25,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,1,6]]},"published-print":{"date-parts":[[2023,2,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2022-058905","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,6]]},"article-number":"e2022058905"}}