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.”

Patients Say the Darndest Things – Happy Doctor’s Day!

In celebration of Doctor’s Day, we asked a few of our physicians what’s the funniest thing a patient has ever told you?

Dr. Mary Jane Piroutek

Dr. Mary Jane Piroutek, emergency medicine specialist

Q: What’s the funniest thing a patient has ever told you?

A:  Kids say funny things all the time. One of my favorites was a little 4 -year-old girl who had ingested coins and they were stuck in her esophagus. When I asked her what happened she shrugged her shoulder and with a mischievous look in her eyes said, “I ate the money, I’m not supposed to eat the money.”  Also recently a patient told me I looked like Snow White (which I don’t) and she called me Dr. Snow White the whole time I took care of her.

Dr. Gary Goodman

Dr. Gary Goodman, medical director, pediatric intensive care unit, CHOC at Mission Hospital

Q: What’s the funniest thing a patient has ever told you?

A: Just recently, I had a patient, who has a mild developmental delay, call me “the boy.”  I would stop in the patient’s room each morning, at which point I’d get asked, “What do YOU want?”

 

Dr. Kenneth Kwon

Dr. Kenneth Kwon, emergency medicine specialist

Q: What’s the funniest thing a patient has ever told you?

A: An adage in pediatric emergency care is when a child comes in with a nosebleed, you don’t ask if he picks his nose, you ask him which finger he uses. When I asked this question to one of my pint-sized patients, he answered that he used all of them, and then proceeded to demonstrate by sticking each of his 10 fingers in his nose individually. It was priceless.

 

Dr. Maryam Gholizadeh

Dr. Maryam Gholizadeh, general and thoracic surgeon

Q: What’s the funniest thing a patient has ever told you?

A: There was a young child around 8-9 years old and we were going to remove his appendix with laparoscopy. I was standing on his left side because with laparoscopy we make our incision on the left side. Just before he went to sleep he looked up at me and said, “Why are you standing on my left? My appendix is on the right.” I was amazed at how knowledgeable this kid was!

 

Dr. Jennifer Ho

Dr. Jennifer Ho, hospitalist

Q: What’s the funniest thing a patient has ever told you?

A: “I want to be a doctor like you … but only for unicorns and fairies.”

 

Dr. Andrew Mower

Dr. Andrew Mower, neurologist

Q: What’s the funniest thing a patient has ever told you?

A: “I don’t eat apples, doctor.”

“Why?”

“Because they keep the doctor away, and I like you, Dr. Mower.”

 

Dr. Laura Totaro

Dr. Laura Totaro, hospitalist

Q: What’s the funniest thing a patient has ever told you?

A: I was examining the mouth of my patient when he proudly showed me his loose tooth and whispered to me that his family had a secret. He then excitedly admitted that his mom was the tooth fairy!  His mother looked at me quizzically and then burst out laughing when she realized what had taken place. Earlier she had admitted to him that she played the role of tooth fairy at home but her son took this quite literally and believed it to actually be her secret full time job for all children.

 

Dr. Mustafa Kabeer

Dr. Mustafa Kabeer, general and thoracic surgeon

Q: What’s the funniest thing a patient has ever told you?

A: A patient asked me what my first name was, and I told him it was Mustafa. He then promptly told me that was the name of his pet lizard!

 

Dr. Sharief Taraman

Dr. Sharief Taraman, neurology

Q: What’s the funniest thing a patient has ever told you?

A: One of my patients told me that I look like the character Flint Lockwood from Cloudy With A Chance of Meatballs and another one thinks I look like the character Linguini from the movie Ratatouille, both of which I found very funny.  Apparently, I give off the nerdy guy vibe.

Know the Risks of Sunken Chest

Pectus excavatum, or sunken chest, is the most common congenital chest wall abnormality in children. Although some medical providers may think that the abnormality is purely a cosmetic problem, the limited chest cavity space can displace the heart as well as limit lung capacity, says Dr. Mustafa Kabeer, a pediatric surgeon at CHOC. Fifteen percent of patients can experience arrhythmia or mitral valve regurgitation, wherein the heart valves allow blood to leak back into the heart, as a result of the inward compression from the sternum.

Dr. Mustafa Kabeer, pediatric surgeon at CHOC Children’s
Dr. Mustafa Kabeer, pediatric surgeon at CHOC

Although the cause is unknown, 40 percent of patients report a family history of pectus excavatum, and 40 percent of cases occur in tandem with scoliosis, says Dr. Kabeer.

Parents may notice an indentation in their child’s chest wall either when they are first born, or closer to puberty, when changes in the chest wall can become more pronounced.

Dr. Kabeer urges medical providers to carefully evaluate symptoms, as they can be subtle and often go unnoticed. If a patient is older than 10 years with pectus deformities, he asks medical providers to look for signs of shortness of breath, difficulty breathing during exercise, unexplained dizziness, occasional chest pain or progressing changes in chest wall appearance.  Some patients notice they are not able to keep up with their peers. If they show even mild symptoms that were not previously recognized, they should be referred to the pectus excavatum team at CHOC, he explains.

The multidisciplinary team is comprised of experts in pediatric pulmonology, cardiology and surgery. The team performs various testing to examine heart and lung function, before and after surgery that expands the chest wall. By using the latest techniques in minimally invasive surgery that dramatically reduces the appearance of incisions, along with recent improvements in pain management, patients are able to return home and get back to their daily activities sooner than ever before.

“We have a comprehensive team ready to evaluate these patients because chances are high that they have some compromise on the cardiopulmonary system given the compression of the sternum. This is not generally noticeable until they are in some kind of increased activity at which point the increased demand from the body has difficulty being met by the heart and lungs,” Dr. Kabeer says.

“These patients should be referred to pediatric surgeons because we are trained in the minimally invasive procedure and should be the first line approach to this problem; there is no need to put a child through a more invasive operation that is not needed,” he adds.

Dr. Kabeer recommends the following referral guidelines:

  • Age < 10 years can be monitored and symptoms and severity of deformity based only on exam should be logged. No studies are necessary at this time unless symptoms are severe at which point, they should be referred to the pectus excavatum team at CHOC, but workup is not necessary prior to referral.
  • Age >10 years with very mild pectus deformities and with no symptoms can be referred or observed.
  • Age >10 years with pectus deformities that are moderate or severe with or without symptoms and mild deformity with symptoms should be referred to the pectus excavatum team at CHOC. No imaging or workup is necessary until seen by the pediatric surgeon.

To contact Dr. Kabeer, or to refer a patient, please call 714-364-4050.

Learn more about CHOC’s surgical services.

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.