CHOC surgeons thriving as productive researchers outside the operating room

CHOC surgeons are known for performing the latest procedures, no matter how complex, in areas including heart, trauma, gastrointestinal, urology and neurosurgery.

Outside the operating room, the seven physicians who make up CHOC’s pediatric general and thoracic surgery team also are excelling in another realm that is critical to CHOC’s mission of developing into one of the nation’s leading pediatric healthcare systems —

Research.

In the last five years, the surgery team has published some 35 papers, bolstered by recent new hires and a renewed commitment to dramatically transform CHOC from its roots as a community children’s hospital to an academic institution.

“It’s unprecedented in the history of pediatric surgery at CHOC – there’s no question about that,” pediatric surgeon Dr. Peter Yu says of the volume of research going on with his team.

“We are proud to be one of the most academically productive divisions at the hospital, and we have some impressive partners in other specialties here,” Dr. Yu says. He calls fellow pediatric surgeon Dr. Yigit S. Guner  the leader behind the recent flurry of research.

“The number of papers that we’ve published in the last several years would be something to be proud of at any children’s health system, even the ones that have a longstanding academic tradition,” Dr. Yu says.

Dr. Yu also cites two more recent hires as critical players: John Schomberg, PhD, a biostatistician in nursing administration and trauma, and Elizabeth Wallace, MPH, a clinical research coordinator in the trauma department in Research Administration.

Schomberg has been instrumental in the team’s research efforts, providing statistical expertise to help investigators, both experienced and new to research, formulate and refine their research questions, Wallace says.

“The research team’s accomplishments are due in large part to the progressive leadership of CHOC executives and the CHOC Research Institute for prioritizing research and providing support needed to make these research endeavors possible,” she adds.

“Though we rarely think of it when we’re waiting for our child to be seen by their physician, ultimately research is the foundation for providing our pediatric patients with leading, innovative and excellent care,” Wallace says. “This group’s research has potential to inform best practices, policy and advocacy that addresses the needs of our community and to advance pediatric care on a more global level. I’m excited to see what the future brings.”

Dr. Guner says conducting research is a central part of his effort to care for children. “We always strive to provide great care, but research raises the bar on what can be done to help our patients,” he says.

Three general areas

The research being conducted by doctors in CHOC’s pediatric general and thoracic surgery division falls into three general categories: general pediatric surgery, trauma and extracorporeal membrane oxygenation (ECMO), a critical care technology that can be used to bypass a failing heart or lungs.

One trauma study, expected to be submitted for publication in February 2021, looked at legal intervention — any injury sustained from an encounter with a law enforcement officer. While studies have been conducted in adults, none have focused on the pediatric population. Legal intervention as cause of traumatic injury in the pediatric trauma population is infrequent yet reported.

Schomberg, Wallace, Dr. Guner and Dr. Yu were among the researchers who examined the National Trauma Data Bank (NTDB) for health disparities related to legal intervention in the pediatric population.

The team’s key finding: Legal intervention in children disproportionately affects the African American population.

Of the 1,069,609 pediatric trauma patients identified in the NTDB, according to an abstract of their paper, 622 sustained injuries involving legal intervention. When these patients were compared to the general pediatric NTDB, they were more likely to be older, male and test positive for illegal drugs or alcohol.

They were more likely to be African American (44.37% vs 17%), Latino (22.82% vs 15.10%), or Native American (0.96% vs 0.94%).

Mortality was higher in trauma involving legal intervention than in the general pediatric trauma population (4.82% vs 1.11%,), particularly in African Americans (63.33% vs 36.66%). Understanding the issue can hopefully point to more effective strategies to minimize harm while protecting public safety.

Variety of research papers

Several of the pediatric general and thoracic surgery division’s research papers concern congenital diaphragmatic hernias (CDH), a rare birth defect in which a hole in the diaphragm allows the intestines, stomach, liver and other abdominal organs to enter the chest, impairing typical lung development.

In another research project in collaboration with St. Louis Children’s Hospital-Washington University and The Children’s Hospital of Philadelphia, Dr. Yu looked at the incidence and length of stay for pediatric appendicitis during the initial days of the COVID-19 pandemic.

Dr. Yu is also currently working on a model to predict a rare traumatic injury referred to as blunt cerebrovascular injury (BCVI) and an interactive web app that would allow a trauma team to better understand their patient’s risk for BCVI.

Dr. Mustafa Kabeer, a CHOC pediatric surgeon, has published work in trauma and neonatology as well as basic science research on the stress response following splenectomy in mice. Dr. Kabeer’s most notable work includes research on the pioneering use of newborn umbilical cords to repair congenital birth defects such as gastroschisis.

Dr. David Gibbs, director of trauma services at CHOC, has been a staunch advocate for research, pushing CHOC to become the leading institution for pediatric trauma research in Orange County while pursuing a Pediatric Level 1 Trauma Center designation.

Dr. Gibbs’ published work includes developing prediction models in the trauma population to better understand prolonged hospital stays and return visits to the emergency department, revisiting the practice of X-rays post chest tube removal, and trauma case reports.

A true team effort

Dr. Yu  says the surgeons in his division work as a team on many research projects.

“Just like you can be a great surgeon,” he explains, “if you go in to operate and you don’t have any anesthesiologists or a nurse or a scrub tech to hand you instruments, there’s only so much that you can do by yourself.”

Dr. Guner says he enjoys understanding as much as possible about the diseases that he treats, and that research is an ideal vehicle to deepen that understanding.

“I really respect people who come here to work and take care of patients – it’s a vital service that people need,” he says. “In addition, I’ve always felt that I really wanted to know about the diseases themselves. Conducting research allows me to contribute to my field and to society at large.”

Another important aspect of research, Dr. Guner adds, is that it helps residents.

“Part of their training is more than taking care of patients,” Dr. Guner explains. “Learning and research go hand in hand. Research makes residents more motivated to work with their mentors and gives them something to do in the early stages of their career by increasing the energy they devote to academia.”

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American College of Surgeons Grants CHOC Prestigious Trauma Center Verification

CHOC Hospital has been verified by the American College of Surgeons as a Level II pediatric trauma center.  This achievement recognizes CHOC’s commitment to providing the highest quality trauma care to injured patients.  CHOC opened its trauma center in 2015.  It is Orange County’s only trauma center focused exclusively on children.

To earn verification, CHOC submitted an extensive application and data.  This was followed by a site visit from a team of surgeons.  They commended CHOC for exceptional work in several areas, including support by the medical staff, nursing educational excellence and the commitment of hospital administration.

Dr. David Gibbs, director, trauma services, and Amy Waunch., MSN, FNP, CEN, trauma program manager
Dr. David Gibbs, director, trauma services, and Amy Waunch., MSN, FNP, CEN, trauma program manager

“Our team of pediatric subspecialists, nurses and staff are dedicated to providing the highest levels of care to   seriously injured children, from the moment they arrive to the day they go home.  Our goal is to give each patient the best chance of survival and recovery,” says Dr. David Gibbs, director, trauma services, CHOC. “We are honored to serve the children and families in Orange County, and are proud to join an elite group of hospitals committed to improving pediatric trauma care.”

As a verified Level II pediatric trauma center, CHOC is a referral resource for communities in Orange County and surrounding regions, and provides:

  • 24-hour coverage by board-certified pediatric trauma surgeons and quick access to pediatric specialties including orthopedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology, internal medicine, plastic surgery, oral and maxillofacial, and critical care
  • Injury prevention and education to the community
  • Continuing education and training for trauma staff
  • Substance abuse screening and patient intervention

CHOC’s trauma center also meets verification standards based on its patient volume and comprehensive quality assessment program.

To be designated a Level II pediatric trauma center, CHOC goes above and beyond to meet the requirements set by Orange County Emergency Medical Services by offering the following.

  • An award-winning pediatric intensive care unit providing intensive and acute care to critically ill surgical and medical patients
  • State-of-the=art operating rooms for performing immediate or emergency surgery using the latest and safest procedures
  • Support services, including child life, social services and psychology, for pediatric patients and their families dealing with traumatic situations
  • Additional hospital services, including a blood bank, radiology and rehabilitation services

Learn more about CHOC’s trauma center.

CHOC Helps Parents with Prenatal Surgery Planning

CHOC surgical servicesSome babies are born with complex conditions requiring surgery during the first few hours following birth. From the moment prenatal testing reveals an abnormality, CHOC is ready to help with the prenatal care and birth planning necessary to ensure the best-possible outcome.

CHOC has a trained and experienced team that includes perinatologists, neonatologists, pediatric surgeons and NICU nurses to guide families through the months before delivery. And families are essential to the planning process.

“The well-being of the child is surprisingly dependent on the well-being of the family, both psychologically and emotionally,” said Dr. David Gibbs, division chief, pediatric surgery, CHOC Specialists. “Preparation helps the family cope better, and the family that is coping better is able to provide better care for their child.”

According to Dr. Gibbs, recent advances in the care and outlook for babies born with abnormalities have come from closer prenatal coordination with perinatologists and families, combined with highly specialized neonatal intensive care. The CHOC NICU is rated by the American Academy of Pediatrics as a Level 4 NICU, the highest designation available and given only to facilities that also provide onsite surgical repair of serious congenital or acquired malformations.

That immediate access to the full NICU medical team, resources and support is critical for babies born with gastroschisis, a condition that requires surgery within the first hour following birth, and omphalocele, which must be corrected within the first few days. For the smallest and sickest, CHOC’s Small Baby Unit offers additional support to help babies grow and recover more quickly with fewer infections and setbacks.

For babies born with congenital diaphragmatic hernia, the CHOC Surgical NICU provides the optimal environment in which to stabilize and gain strength before surgery. One room inside the CHOC NICU converts into a state-of-the-art operating room, allowing pediatric surgeons to perform delicate procedures within the unit.

And babies born with congenital cystic adenomatoid malformation (CCAM) may actually get to go home for continued evaluation months before surgery.

Dr. Gibbs added that an important element of prenatal planning is deciding in advance where your baby will be born. Moms who know their baby will need surgery may choose to deliver at a hospital that is near a pediatric facility like CHOC. When the baby is born, the CHOC Transport Team is ready 24 hours a day to transport the baby to CHOC from hospitals throughout the region. Specially trained and equipped, this team uses ground and air transportation to travel to and from hospitals throughout Orange, Los Angeles, Riverside, San Bernardino and San Diego counties — and even beyond.

“We expect most children will do well and have normal lives,” Dr. Gibbs said. “But the first step is meeting with the perinatologist, pediatric surgeon and NICU team. Starting that relationship as soon as possible will make the process of coping with what may seem to be an overwhelming process a lot easier.”

CHOC’s surgeons provide cardiothoracic surgery, gastrointestinal (GI) surgery, general surgery, neurosurgery, urological surgery, otolaryngological (ENT) surgery, plastic surgery, ophthalmologic surgery and orthopaedic surgery.

Learn more about surgical services at CHOC.

In the Spotlight: CHOC Specialists Pediatric Surgery

“I would never live in a community that doesn’t have a children’s hospital,” says Dr. Mustafa Kabeer, a CHOC Specialists pediatric surgeon.

Dr. Kabeer and his three partners – all fathers – firmly believe that ill or injured children require the clinical expertise and compassionate, family-centered care unique to pediatric facilities, like CHOC.

“Kids aren’t small adults.  From tiny newborns to adult-sized teens, each pediatric patient deserves access to the technology, environment and people that can only be found at a children’s hospital.  Here at CHOC, everything we do – each and every day – is focused on children.  We deliver a high level of care in a friendly setting that promotes collaboration among staff and families,” explains Dr. Kabeer.

Philosophy of Caring
Together, Dr. Kabeer and his partners, Dr. David Gibbs, Dr. Troy Reyna and Dr. Saeed Awan, abide by a philosophy of care that engenders trust between them and their patients and families. More specifically, they treat their patients like they’d want their own children treated.  Similarly, they treat the parents the way they’d want to be treated.

“We encourage parents to come to us with questions so they can learn as much as possible.  As parents, we would do the same thing if we were in their shoes. They need to do whatever they can to feel like they are being good parents, and we want to partner with them in that effort.  We have the same goal:  getting their kids better,” says Dr. Gibbs.

This commitment is extended to referring physicians.

“Physicians in the community should always feel comfortable contacting us.  We answer their calls directly and get their patients seen promptly.  With telemedicine and additional technological advances, we’re always exploring ways to extend our reach into the community,” says Dr. Reyna.

Scope of Services
In addition to performing the more common surgeries, such as hernia repair, the group offers minimally invasive surgery, the Nuss procedure (for the repair of Pectus Excavatum), robotic surgery and thoracic surgery.  With the addition of Dr. Reyna, approximately two years ago, and Dr. Awan, about eight months ago, CHOC Specialists Pediatric Surgery has increased the scope of clinical activities, performing an increasing number of thoracic surgeries and treating more cases of inflammatory bowel disease, for example.

“One of the reasons my colleagues and I chose this specialty is the breadth and depth of our field.  We completed one of the longest pathways in the U.S. medical system to become pediatric surgeons.  This training prepared us to operate in a number of areas, from the neck to the pelvic region.  And these are the areas in which we have performed thousands of surgeries throughout our years of practice.  As a group, we bring this experience – and the rigorous training it took to get here – to our patients and their families,” says Dr. Awan.

Commitment to CHOC
As advocates for their patients and families, as well as the broader medical community, the pediatric surgeons are actively involved at the hospital.

Dr. Gibbs is president of the medical staff and the interim medical director of pediatric trauma.
Dr. Kabeer has served on the CHOC board of directors and currently serves as secretary/treasurer of the Pediatric Subspecialty Faculty, Inc. board of directors.  All four physicians are active on various committees and in resident training.  All are involved in CHOC’s surgical neonatal intensive care unit, which they created in partnership with the hospital’s neonatology division.

“We couldn’t imagine being the kind of physicians we strive to be without a deep connection to the hospital.  It’s been very rewarding to be a part of CHOC’s recent evolution, which gives us a greater ability to care for our kids,” says Dr. Kabeer.

With a primary office in Orange, CHOC Specialists Pediatric Surgery has offices in Corona, Mission Viejo and Newport Beach. To refer a patient, please call 714-364-4050.