Assessment of Case Cancellation Equity in Surgical Scheduling (ACCESS)
Principal Investigators: Dr. Teresa Skelton and Dr. Matthias Görges
Ethics number: H24-03311
Postponing and rescheduling a planned surgery can have negative effects on the patient and their family, including prolonged anxiety and pain, potential medical deterioration, increased time off work and increased travel costs. At BC Children’s Hospital, surgeries may be postponed if there are not enough beds for patients to recover after their procedure. An American study recently combined hospital cancellation data with geographic data and found a strong relationship between cancellation and neighborhood opportunity. Specifically, there was an increased cancellation risk in low-opportunity neighborhoods, highlighting a potential inequality in access to care. Our team is wondering if patients who live farther from BC Children’s Hospital (non-local patients) experience more surgery postponements than patients who live in the Lower Mainland (local patients). You may be approached to participate in an interview with our research team if your surgery was postponed due to hospital resource issues (e.g., bed availability).
Biomarker Indicators for Nutrition and Growth Outcomes (BINGO)
Principal Investigator: Dr. Cheryl Peters
Ethics number: H24-03307
Providing the right type of nutrition for a child before and after heart surgery can improve their outcomes. Identifying children who are at high risk of poor nutrition and providing them with the right type of nutrition can minimize problems after surgery. Our team reviewed five years of patient data at the BC Children’s Hospital. We found that patients who developed malnutrition between birth and heart surgery had a higher chance of developing complications. Complications can lead to a longer stay in the intensive care unit, additional hospital procedures. This study will examine biomarkers before surgery to find out how they relate to patient outcomes after surgery. Biomarkers are found in bodily fluids, such as blood. Our team will test two biomarkers; albumin and prealbumin, to find out if changing your nutrition can help you recover after surgery. You may be invited to participate if you are aged 0 to 18 and are having heart surgery at BC Children’s Hospital.
Modification of automated cardiac function prediction algorithms from ‘non-expert’ echocardiographers in pediatric patients (ECHO)
Principal Investigator: Dr. Heng Gan
Ethics number: H22-03210
Cardiac output measures the volume of blood pumped by the heart per minute. Good cardiac output ensures that the tissues in your body receive enough oxygen and other nutrients. During procedures with anesthesia, it is important for anesthesiologists to maintain good cardiac output in the patient. One way to identify cardiac output is by taking images of a patient’s heart with a type of ultrasound called an echocardiogram (or “ECHO”). Cardiologists are trained to take and interpret ECHO images and other doctors such as anesthesiologists or emergency medicine doctors are now being trained to take these images, as well. However, reading ECHOs can be challenging, even for trained doctors. To help doctors, The Hospital for Sick Children and the University of Toronto have created a software to help read images and estimate cardiac output in children. The program has already proven accurate and reliable in adults, but has yet to be tested in children. You may be invited by our research team to participate if you are 18 years old or younger and are having a procedure involving anesthesia at BC Children’s Hospital. If you decide to participate, non-cardiac-expert doctors will take ECHO images of your heart after you are asleep and before your surgery. These images will help train the software for accuracy to improve future clinical care.
Effects of End Tidal Carbon Dioxide Concentration on Depth of Anesthesia in Children Undergoing Total Intravenous Anesthesia
Principal Investigator: Dr. Chris Chin
Ethics number: H23-03546
Carbon dioxide (CO2) is a by-product of our metabolism and is removed from the body when we breathe out. High levels of CO2 can cause you to be sleepy or have deeper sedation. It may also benefit patients who are asleep under anesthesia, possibly by reducing infection rates, reducing nausea, reducing recovery time from anesthesia or reducing pain signals. During general anesthesia, anesthesiologists keep patients asleep with anesthesia gases or by giving medications into a vein. These medications may slow the patients breathing, so anesthesiologists will control their breathing through an endotracheal tube (breathing tube). The anesthesiologist may also monitor a patient’s level of consciousness using tools such as a Bispectral Index (BIS) which analyzes a patient’s brain activity. Our team aims to test if different levels of CO2 during intravenous anesthesia are linked with different levels of sedation (or sleepiness) in children, as measured by BIS. You may be invited to participate if you are ages 3-11 years old undergoing a procedure with little expected pain.
Perioperative Experience of Children with Autism: A Narrative Study (PECANS)
Principal Investigator: Zoë Brown
Ethics number: H25-02624
Many children with autism spectrum disorder (ASD) find comfort in consistent routines and predictable environments, which may be disrupted in clinical settings. In fact, anxiety or negative experiences at the hospital can be upsetting for the child and their family and can cause delays in clinical care for the child. Therefore, it is imperative to create a safe perioperative environment that will positively reinforce healthcare for the child and their family, leading to better health outcomes for the patient. Recognizing the steps that have been taken at BC Children’s Hospital to ensure a positive experience for children with ASD, we have yet to hear from their parents/caregivers if the approach we have been taking is effective and how it can be improved. You may be invited to participate in an interview if you are the parent or caregiver of a child aged 6 or older who has been diagnosed with ASD and is having elective day surgery at BC Children’s Hospital.
Postoperative Pain Study in Children – A Longitudinal Evaluation (POPSICLE)
Principal Investigator: Dr. Lynnie Correll
Ethics number: H24-00199
Most children make a full recovery after surgery; however, some children may develop chronic pain. This can be distressing for these patients and their families. There are many factors which increase the risk for chronic pain, including biological, psychological, social, and environmental elements. Our team, along with the study leaders in Perth, Australia, want to find out how psychological, social, and environmental elements may play a role in the development and maintenance of chronic pain in children. Specifically, we want to find out if parental anxiety may have an influence. Understanding these factors can help clinicians develop preparation strategies that address parental anxiety and reduce poor pain outcomes in children. Patients and caregivers may be invited by our research team to complete a series of surveys if you are attending BC Children’s Hospital for a circumcision, hypospadias, orchidopexy, laparoscopic appendicectomy, laparoscopic appendectomy, or scrotal exploration procedure.
Pediatric Outcomes and Recovery with Peri-Operative Iron Supplement Evaluation (PORPOISE)
Principal Investigator: Dr. Teresa Skelton
Ethics number: H25-00010
Varus-derotation osteotomy (VDRO) surgery is done to prevent or address hip displacement in children. VDRO is a long surgery, where between 10% and 25% of patients need a blood transfusion. Some patients having this surgery may be malnourished and have low amounts of iron in their blood. These patients may have an increased risk of needing a blood transfusion during or after surgery and an increased length of stay in hospital after their surgery. Improving a patient’s iron intake and nutrition before surgery might lead to a lower chance of needing a blood transfusion and a shorter stay in hospital. You may be invited to participate in this study if you are between 0 and 18 years old and are having VDRO surgery. If you decide to participate, your nutrition will be assessed by a dietician. If your iron is low, you will be prescribed iron during the months leading up to your surgery. We will ask you to fill out online surveys and complete an optional interview about your experience.
BC Children’s Hospital ‘Regional Anesthesia Postoperative Information Digitally for Recovery at Home’ (RAPID Recovery @ Home) platform: developing an at-home pain management tool after orthopedic surgery in adolescents with peripheral nerve catheters
Principal Investigator: Dr. Randa Ridgway
Ethics number: H24-03369
At BC Children’s Hospital, over 100 adolescent patients per year receive a common knee surgery called anterior cruciate ligament (ACL) reconstruction. Often, these patients are otherwise healthy and can go home on the same day as their surgery. To succeed in their recovery at home, patients need a plan that embraces the whole bio-psycho-social model for pain management (pharmacological, psychological, and physical strategies). Effective pain management and early mobility exercises are key to return to full function after surgery. The use of a peripheral nerve catheter 3-5 days after surgery as part of a multimodal strategy reduces the need for opioids. Once a day, follow up by the APS team limits opportunities to reinforce pain management and movement strategies. Our team aims to design a digital tool that incorporates pain management strategies prompted by the patients’ self-reported pain scores. This tool aims to include resources and strategies that improve recovery, enhance communication with adolescents after surgery, increase satisfaction after hospital discharge, and empower adolescents to engage as active participants in their recovery. You may be invited to participate in focus groups if you have undergone ACL reconstruction surgery at BC Children’s Hospital.
Co-creation of an Appealing and Effective Perioperative Integrative Toolkit using Patient and Family Focus Groups (STARFISH)
Principal Investigator: Dr. Lynnie Correll
Ethics Number: H24-03302
About 1 in 5 children who have surgery still have pain one year later. Good anxiety and pain management strategies, both before and after surgery, can help lower post-operative anxiety and pain, as well as make recovery easier, faster and more successful. Some factors that can make the surgical experience worse for adolescents include feeling anxious, having trouble coping, and focusing too much on pain. The good news is these factors can be changed before surgery to improve outcomes after surgery. Our team is building a digital application for patients to use before and after surgery to help lower these stressors and help them cope. The app will use individualized, integrative (or complementary) medicine (IM) techniques. These techniques use a holistic approach to treat the whole person, not just their body. Some examples of IM techniques you may have heard of are breathing exercises, acupressure or tapping. We know that including patients’ values in making clinical care decisions empowers patients, increases their knowledge, and lowers their anxiety. The purpose of this study is to partner with patients, caregivers, and clinicians to co-select the most appealing and acceptable, evidence-based, relaxation-promoting IM techniques that can be easily shared by digital delivery. You may be invited by our research team to participate in focus groups to help develop this app if you are an adolescent patient (13 to 19 years old) or the caregiver of a patient who has undergone or will soon undergo elective major surgery.