1
|
Salimi-Jazi F, Sabapaty A, Santos Dalusag K, Abrajano C, Nguyen J, Robinson B, Caruso TJ, Rodriguez S, Hartman G, Chao SD. Let Kids Play: Using Virtual Reality as a Substitute for General Anesthesia for Minor Procedures in Pediatric Population. J Pediatr Surg 2024; 59:992-996. [PMID: 38307749 PMCID: PMC11031342 DOI: 10.1016/j.jpedsurg.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 12/18/2023] [Accepted: 01/03/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND In the pediatric population, virtual reality (VR) has been used as an adjunct to augment analgesia and reduce the need for opioids. In this study, we review our experience using VR in lieu of anesthesia or sedation to enable minor procedures in children. METHODS A retrospective chart review study was performed on patients who presented to our institution from 2019 to 2022 for hormone implant placement, exchange, or removal with VR distraction. Demographic and procedure information was recorded. The primary outcome was successful procedure completion without requiring pharmacologic sedation or analgesia. RESULTS A total of 111 patients underwent the following minor procedures with VR and without anesthesia or sedation. Fourteen patients had multiple encounters resulting in a total of 126 encounters. The median age was 11 [6] years. 43 patients were female, 23 were female to male, 6 were non-binary, 7 were male, and 32 were male to female. 58 % had private insurance. Most common diagnosis was precocious puberty (54 %) followed by gender dysphoria (46 %). Most common procedure was implant placement (72 %). 69 % of procedures were performed in the clinic and 31 % in the OR. All procedures were completed without requiring the administration of additional sedation or anesthesia. None of the patients required intravenous catheter placement for the procedure. No intra-procedural complications were recorded. CONCLUSION VR is a feasible option that can spare children from sedation or general anesthesia for minor procedures. VR may enable minor procedures in children to be successfully performed in clinic setting. LEVEL OF EVIDENCE: 4
Collapse
Affiliation(s)
- Fereshteh Salimi-Jazi
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Akanksha Sabapaty
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Kyla Santos Dalusag
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Claire Abrajano
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Jackie Nguyen
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Blaine Robinson
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Thomas Jon Caruso
- Department of Anesthesia, Stanford University School of Medicine, Stanford, CA, USA
| | - Samuel Rodriguez
- Department of Anesthesia, Stanford University School of Medicine, Stanford, CA, USA
| | - Gary Hartman
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Stephanie D Chao
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
| |
Collapse
|
2
|
Mueller C, Adams M, Abrajano C, Yousefi R, Dalusag KS, Hui T, Su W, Fuchs J, Chiu B. A standardized treatment protocol for pilonidal disease can influence the health mindset of adolescents. Langenbecks Arch Surg 2024; 409:93. [PMID: 38467936 DOI: 10.1007/s00423-024-03282-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 03/06/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE Pilonidal disease (PD) significantly impacts patients' quality of life and requires regular maintenance behaviors to achieve cure. Health mindset is a psychological construct which can influence health behaviors and outcomes, with a growth mindset being associated with better outcomes than a fixed. We propose that participation in a standardized treatment protocol can affect the health mindset for adolescents with pilonidal disease. METHODS PD patients' demographics, recurrence, and comorbidities were prospectively collected from 2019 to 2022. We assessed patients' mindset score at initial presentation using the validated Three-Item Mindset Scale (1-6) then reassessed during follow-up. t-test was used to compare baseline and follow-up mindset scores and stratified by recurrence or comorbidities. p ≤ 0.05 was considered significant. RESULTS A total of 207 PD patients (108 males, 99 females) with mean age 18.2 ± 3.7 years were followed for 351 ± 327 days. Mean baseline mindset score (4.76 ± 1.27) was significantly lower than mean follow-up mindset score (5.03 ± 1.18, p = 0.049). Baseline mindset score was significantly lower among patients with PD recurrence (4.00 ± 0.66) compared to those without recurrence (4.8 ± 1.29, p = 0.05). Among patients with PD recurrence, mean baseline mindset score (4.00 ± 0.66) was significantly lower than mean follow-up mindset score (5.27 ± 0.93, p = 0.0038). Patient comorbidity did not affect the baseline or follow-up mindset score. CONCLUSIONS Participation in a standardized treatment protocol is associated with the development of a stronger growth mindset over time for patients with PD. Furthermore, a growth mindset was linked to lower recurrence rate than a fixed mindset. Further investigations into how treatment approaches can work in concert with health mindset are proposed.
Collapse
Affiliation(s)
- Claudia Mueller
- Department of Surgery, Stanford University, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA
| | - Madeline Adams
- Department of Surgery, Stanford University, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA
| | - Claire Abrajano
- Department of Surgery, Stanford University, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA
| | - Razie Yousefi
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, TX, USA
| | - Kyla Santos Dalusag
- Department of Surgery, Stanford University, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA
| | - Thomas Hui
- Department of Surgery, Stanford University, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA
| | - Wendy Su
- Department of Surgery, Stanford University, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA
| | - Julie Fuchs
- Department of Surgery, Stanford University, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA
| | - Bill Chiu
- Department of Surgery, Stanford University, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA.
| |
Collapse
|
3
|
Sabapaty A, Salimi-Jazi F, Abrajano C, Yousefi R, Garza D, Dalusag KS, Hui T, Su W, Mueller C, Fuchs J, Chiu B. Comorbidities are not associated with pain symptom or recurrence in patients with pilonidal disease. Pediatr Surg Int 2024; 40:66. [PMID: 38436736 DOI: 10.1007/s00383-024-05644-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Comorbidities can potentially impact the presentation or outcome of patients with pilonidal disease (PD) due to poor wound healing or increased inflammatory response. We hypothesized that certain comorbidities could lead to worse pain or higher recurrence rate. METHODS A retrospective study was performed on all PD patients treated with standardized minimally invasive protocol at our clinic 2019-2022. Patients' demographics, comorbidities, initial/follow-up pain score, pain duration, and recurrence were recorded. Data were analyzed by t test and Chi-square test. RESULTS Of 207 total PD patients (108 male, 99 female), 61 had comorbidities. Mean age was 18.2 years. The recurrence rate was 7%, and patients with recurrence were significantly younger. Associated comorbidities included mood/psychiatric disorders (31%), asthma/respiratory illness (30%), obesity-related illness (15%), gastrointestinal disorders (13%), diabetes (10%), thyroid disease (8%), cardiac disease (8%), musculoskeletal/connective tissue disorders (7%), immunologic disease (7%), inflammatory bowel disease (5%), and chest wall disorders (3%). The presence of comorbidities was not associated with PD recurrence. By dividing patients into adolescents (< 18 years) and adults (≥ 18 years), we found no association between comorbidity and recurrence in either group. 55% of patients had pain as an initial symptom. The initial pain score, pain duration, and pain score at follow-up were not associated with comorbidities. The comorbidities and recurrence were not associated with patient age or sex. CONCLUSIONS Having comorbidities was not associated with pain symptoms or recurrence in PD patients. Even though patients with recurrence were younger, there was no association between comorbidity and recurrence in either adolescents or adults.
Collapse
Affiliation(s)
- Akanksha Sabapaty
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Fereshteh Salimi-Jazi
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Claire Abrajano
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Razie Yousefi
- Department of Biochemistry and Molecular Biology, 301 University Boulevard Galveston, University of Texas Medical Branch, 108 Basic Science Building, Galveston, TX, 77555, USA
| | - Deanna Garza
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Kyla Santos Dalusag
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Thomas Hui
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Wendy Su
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Claudia Mueller
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Julie Fuchs
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Bill Chiu
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA.
| |
Collapse
|
4
|
Adams M, Abrajano C, Dalusag KS, Hui T, Su W, Mueller C, Fuchs J, Chiu B. Regular epilation alone is an acceptable treatment for symptom-free pilonidal patients. Pediatr Surg Int 2023; 39:285. [PMID: 37906293 DOI: 10.1007/s00383-023-05577-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2023] [Indexed: 11/02/2023]
Abstract
INTRODUCTION Patients with mild pilonidal disease often experience symptom resolution without excision. We hypothesized that treating symptom-free/asymptomatic pilonidal patients with regular epilation alone had similar recurrence rate as patients who were also treated surgically. METHOD Patient data were prospectively collected 2/2019-11/2022 at our Pilonidal Clinic. All patients received regular epilation; all patients presented before 12/2020 also underwent pit excision using trephines. Starting 1/2021, only symptomatic patients underwent pit excision; symptom-free patients at presentation received only regular epilation. Recurrence rates were statistically analyzed. RESULTS 255 patients (male:54.4%, female:45.6%), median age 17.3years (IQR:15.8-19.1) were followed for median 612.5days (IQR:367.5-847). 44.1% identified as Hispanic, 36.5% Caucasian, 17.1% Asian, 2.4% Black. Median symptom duration at presentation was 180.5days (IQR:44.5-542.5). 160 patients were initially treated with surgical excision and regular epilation, while 95 patients with regular epilation only. The failure rate between patients who received surgical excision initially and recurred (9.4%) and patients who received epilation only and recurred (12.6%) was similar, after controlling for sex, race, age, comorbidities, skin type, hair color, hair thickness (p > 0.05). Patients who recurred after only undergoing regular epilation all underwent surgical excision, median 100days (IQR:59.5-123.5) after initial presentation. CONCLUSION Regular epilation alone is an acceptable treatment for symptom-free pilonidal patients.
Collapse
Affiliation(s)
- Madeline Adams
- Department of Surgery, Stanford University, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Claire Abrajano
- Department of Surgery, Stanford University, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Kyla Santos Dalusag
- Department of Surgery, Stanford University, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Thomas Hui
- Department of Surgery, Stanford University, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Wendy Su
- Department of Surgery, Stanford University, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Claudia Mueller
- Department of Surgery, Stanford University, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Julie Fuchs
- Department of Surgery, Stanford University, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Bill Chiu
- Department of Surgery, Stanford University, 453 Quarry Road, Palo Alto, CA, 94304, USA.
| |
Collapse
|
5
|
Salimi-Jazi F, Abrajano C, Yousefi R, Garza D, Dalusag KS, Sabapaty A, Rafeeqi T, Hui T, Su W, Mueller C, Fuchs J, Chiu B. Increasing Amount of Hair Reduction Using Laser Correlates With Lower Probability of Recurrence in Patients With Pilonidal Disease. J Pediatr Surg 2023:S0022-3468(23)00174-4. [PMID: 36934004 DOI: 10.1016/j.jpedsurg.2023.02.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 02/20/2023] [Indexed: 03/20/2023]
Abstract
BACKGROUND Hair at the gluteal cleft plays a key role in the development and recurrence of pilonidal disease (PD). We hypothesized that more hair reduction achieved using laser could correlate with lower chance of PD recurrence. METHODS PD patients who underwent laser epilation (LE) were categorized by Fitzpatrick skin type, hair color, and hair thickness. Photos taken at LE sessions were compared to determine hair reduction amount. LE sessions completed prior to the recurrences were recorded. Groups were compared using multivariate T-test. RESULTS 198 PD patients had mean age 18.1 ± 3.6 years. 21, 156, and 21 patients had skin types 1/2, 3/4, and 5/6, respectively. 47 patients had light- and 151 had dark-colored hair. 29 patients had fine hair, 129 medium, and 40 thick. Median follow-up was 217 days. 95%, 70%, 40%, and 19% of patients reached 20%, 50%, 75%, and 90% hair reduction after mean LE sessions of 2.6, 4.3, 6.6, 7.8 sessions, respectively. To reach 75% hair reduction, patients require a mean of 4.8-6.8 LE sessions, depending on different skin/hair characteristics. PD recurrence rate was 6%. Probability of recurrence after 20%, 50%, 75% hair reduction was decreased by 50%, 78%, 100%, respectively. Dark hair and skin type 5/6 were associated with higher recurrence rates. CONCLUSION Patients with dark-color and thick hair require more LE sessions to achieve certain degree of hair reduction. Patients with dark hair and skin type 5/6 were more likely to recur; more hair reduction correlated with lower chance of recurrence. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Fereshteh Salimi-Jazi
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Stanford, CA, USA
| | - Claire Abrajano
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Stanford, CA, USA
| | - Razie Yousefi
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, TX, USA
| | - Deanna Garza
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Stanford, CA, USA
| | - Kyla Santos Dalusag
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Stanford, CA, USA
| | - Akanksha Sabapaty
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Stanford, CA, USA
| | - Talha Rafeeqi
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Stanford, CA, USA
| | - Thomas Hui
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Stanford, CA, USA
| | - Wendy Su
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Stanford, CA, USA
| | - Claudia Mueller
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Stanford, CA, USA
| | - Julie Fuchs
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Stanford, CA, USA
| | - Bill Chiu
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Stanford, CA, USA.
| |
Collapse
|