Humza Thobani
Postdoctoral Scholar, Pediatric Surgery
All Publications
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Can we do less? A review of imaging practices for evaluating cervical spine injuries in pediatric blunt trauma patients.
Pediatric surgery international
2025; 41 (1): 147
Abstract
This study aimed to investigate whether a validated clinical decision tool or other clinical features at presentation could predict cervical spine injury in a cohort of children who were selected for cervical spine imaging following blunt trauma.We conducted a retrospective review of all patients < 18 years presenting to our institution with blunt trauma who underwent cervical spine imaging over a 3-year period. Relevant data on patients' clinical presentation, imaging, management and outcomes were compiled. The NEXUS screening tool was retroactively applied to all patients. Univariable and multivariable logistic regression was conducted to identify independent predictors of CSI.1,321 patients presented with blunt trauma, out of which 484 underwent cervical spine imaging and were included in our study. Computerized tomography (CT) scans were conducted in most patients (n = 447, 92.4%). NEXUS risk stratification failed to identify 9 CSIs and had an overall sensitivity of 80.4%. Out of all the possible risk factors we investigated, only chest/torso trauma was found to be significantly associated with CSI on multivariate regression.We were unable to identify a screening tool or predictive model which could be used to further reduce imaging practices at our institution without missing clinically significant CSIs.
View details for DOI 10.1007/s00383-025-06053-3
View details for PubMedID 40425891
View details for PubMedCentralID 9671138
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Standardized Classification System for Pilonidal Disease and Recurrence Rate after Treatment.
Journal of the American College of Surgeons
2025
Abstract
BACKGROUND: Current classification systems for pilonidal disease do not objectively profile disease severity, limiting their clinical applicability. This study aimed to validate a novel pilonidal disease severity (PDS) staging system by testing its correlation with disease recurrence.STUDY DESIGN: This was a prospective cohort study set at a high-volume, specialized pilonidal care center. All patients presenting with pilonidal disease were included. The main effector under study was PDS stage assigned at initial presentation. Secondary effector variables were an open wound >1 cm on presentation (descriptor W) or prior surgical resection (descriptor R). The primary outcome was pilonidal disease recurrence at 1- and 2-year follow-up.RESULTS: A total of 411 patients met criteria, with 212 and 206 patients completing 1- and 2-year follow-up respectively. Among patients who completed 1-year follow-up, recurrence occurred in 0.0%, 2.3%, 8.3% and 20.8% of patients with PDS stage 0, 1, 2, and 3 disease at initial presentation respectively (log-rank test, p=0.017). At 2-years, recurrence was noted in 0.0%, 4.8%, 12.7% and 27.5% of patients with PDS stage 0, 1, 2, and 3 disease respectively (log-rank test, p=0.010). The presence of an open wound at initial presentation and prior surgical resection were not associated with risk of recurrence (W, p=0.94; R, p=0.98).CONCLUSIONS: This study describes the first staging system for pilonidal disease which correlates with risk of recurrence. Upon further external validation, the PDS staging system may be utilized both clinically to tailor treatment regimens to risk of disease recurrence; and in research to standardize disease severity when comparing different therapeutic interventions.
View details for DOI 10.1097/XCS.0000000000001454
View details for PubMedID 40401769
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Predictors of Adverse Outcomes Following Nephrectomy for Pediatric Renal Tumors: Analysis of National Surgical Quality Improvement Program-Pediatric Data.
The Journal of surgical research
2025; 310: 128-136
Abstract
This study aimed to characterize the 30-d outcomes of nephrectomies for renal tumors (RTs) in children and identify predictors of operative morbidity.We queried the National Surgical Quality Improvement Program-Pediatric database for children aged <18 y with RTs who underwent nephrectomy from 2012 to 2021. Relevant clinical variables relating to patient demographics, outcomes, and type of nephrectomy were extracted. The primary outcome variable was any major adverse outcome (MAO). The secondary outcome variable was intra- or post-operative transfusion of blood products. Multivariable logistic regression was conducted to identify possible predictors of the primary or secondary outcomes after multiple imputations to account for missing data.We identified 1759 patients with a median age of 3.6 y (interquartile range: 1.9-5.8 y) and an equal sex distribution (51.4% female). Approximately 4.7% of patients had an MAO and 29.8% had a transfusion event. On multivariate regression, the predictors most strongly associated with MAO were a history of chronic lung disease (adjusted odds ratio [aOR] = 1.329, 95% confidence interval [CI] = 1.206-1.465), preoperative nutritional support (aOR = 1.129, 95% CI = 1.074-1.188), and prior inotropic support (aOR = 1.100, 95% CI = 1.010-1.198). A nephron sparing approach was associated with a slightly higher odds of both MAO (aOR = 1.044, 95% CI = 1.015-1.074) and intra-/post-operative transfusion (aOR = 1.109, 95% CI = 1.045-1.177).Patients undergoing nephrectomy for RTs had low rates of surgical mortality and complications. A nephron sparing approach appeared to be associated with a slightly higher odds of operative morbidity-this may be because patients selected for nephron sparing surgery likely had higher stage, bilateral tumors, or a genetic predisposition to developing RTs.
View details for DOI 10.1016/j.jss.2025.03.026
View details for PubMedID 40279916
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Pediatric neurosurgery without pediatric neurosurgeons: a comparison of outcomes of pediatric brain tumor resections in Pakistan with a national US surgical database.
Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
2025; 41 (1): 124
Abstract
There are currently no specialized pediatric neurosurgeons in Pakistan. The extent to which this impacts the outcomes of children undergoing surgery for neurological conditions in the country is unclear. We aimed to investigate whether outcomes of brain tumor resections in children at our high-volume center in Pakistan were comparable to those performed by pediatric neurosurgeons in a large, validated US surgical database.A multi-center collaborative collected clinical data on supratentorial and infratentorial craniotomy procedures (SC and IC, respectively) for malignant brain tumors in children < 18 years at a single center in Pakistan from 2015 to 2022. Similarly, the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) 2021 dataset was queried to extract a comparable cohort of patients. Rates of adverse outcomes and quality metrics were compared between the groups using appropriate statistical tests.We collected data on 105 Pakistan patients and 570 NSQIP-P patients. Patient demographics were similar for both groups. A total of 350 and 325 children underwent SC and IC, respectively. Postoperatively, children in the Pakistan cohort had worse neurological outcomes, including higher rates of postoperative seizures (SC, p < 0.001; IC, p = 0.003) and focal neurological deficits (SC, p = 0.003; IC, p < 0.001). Furthermore, Pakistani children undergoing SC had higher rates of postoperative mortality (p = 0.002), surgical site infections (p = 0.015), and deep wound infections (p = 0.027), while those undergoing IC had higher rates of unplanned intubations (p < 0.001) and prolonged postoperative mechanical ventilation > 48 h (p = 0.004) compared to their US counterparts captured in NSQIP-P data.Despite the availability of neuroimaging, cancer therapeutics, and intensive care at our center, children undergoing brain tumor resections had worse outcomes than their US counterparts. There is likely a need for specialized pediatric neurosurgical health services to improve outcomes of children undergoing complex neurosurgical procedures in Pakistan.
View details for DOI 10.1007/s00381-025-06775-8
View details for PubMedID 40014156
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How low should we go? Outcomes of ECMO in neonates with low gestational age or birth weight.
Pediatric surgery international
2025; 41 (1): 74
Abstract
PURPOSE: Initial recommendations for ECMO had relative contraindications for low birth weight (BW) or low gestational age (GA) babies. However, more recent literature has demonstrated improved and acceptable outcomes of ECMO in smaller neonates. The purpose of this study was to understand both utilization and survival in patients with lower GA and BW.METHODS: All neonates captured in the Extracorporeal Life Support Organization (ELSO) registry who underwent a single ECMO run from 2009 to 2019 were included. The primary outcome measure was mortality and the secondary outcome measure was major adverse outcomes, defined as a composite outcome variable any severe ECMO complications. Univariate and multivariable statistical tests were performed to estimate the association between GA and BW with both outcome variables.RESULTS: A total of 14,167 cases met inclusion criteria. Univariate analysis noted that birth weight, gestational age, ECMO mode, pulmonary support type, pH and ventilator settings were highly significant predictors of survival. Multivariable assessment noted significant linear relationship of mortality rates with increasing GA and BW (p<0.001, OR=0.82 GA, 0.51 BW). The highest ECMO-related mortality was observed in neonates with GA 30-31weeks and BW 1.5-2.0kg, with a 70-75% in-hospital mortality rate.CONCLUSIONS: Decreasing GA and BW were strongly correlated with increasing odds of mortality and/or ECMO-related complications. However, even in low GA or BW neonates, survival may be possible in up to a quarter of patients put on ECMO.
View details for DOI 10.1007/s00383-025-05972-5
View details for PubMedID 39864029
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Age and Weight Stratified Outcomes of Single Stage Endorectal Pull-through Procedures for Hirschsprung's Disease in Children: Analysis of NSQIP-P Data.
Journal of pediatric surgery
2025: 162168
Abstract
We aimed to analyze the effect of age and weight on 30-day outcomes of single-stage endorectal pull tthrough (ERPT) procedures for Hirschsprung's Disease (HD) using the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database to identify an optimal time for surgery.We queried NSQIP-P for children <2 years with HD who underwent ERPT between 2016-2021 and did not have a preoperative stoma. Patients were stratified by age (<3 months, 3-6 months and >6 months) and weight (<4 kg, 4-8 kg, and >8 kg) at the time of surgery. The primary outcome measure was major adverse outcomes, and the secondary outcomes were 30-day unplanned readmission and reoperation. Multivariable logistic regression was conducted to analyze the association between age and weight and each outcome.A total of 1002 patients were included with a median age of 31 days (IQR: 10-106 days). Patients were stratified by age (n = 702, 70.1 %; n = 158, 15.8 %; n = 142, 14.2 % respectively from youngest to oldest) and weight (n = 472, 47.1 %; n = 421, 42.0 %; n = 109, 10.9 % respectively from lowest to highest weight) groups. On multivariable analysis, age>6 months and weight>8 kg were independently associated with a higher rate of major complications (aOR = 2.741, 95 % C.I. = 1.234-5.880 and aOR = 4.627, 95 % C.I. = 1.761-11.775 respectively). Conversely, being in the highest age (aOR = 0.359, 95 % C.I. = 0.176-0.699) and weight brackets (aOR = 0.396, 95 % C.I. = 0.171-0.801) independently predicted lower 30-day readmission rates.Earlier single-stage ERPT for HD was found to be associated with lower complication rates in a select group of patients but may result in increased rates of readmissions and hospital resource utilization.Level III evidence.Retrospective cohort study.
View details for DOI 10.1016/j.jpedsurg.2025.162168
View details for PubMedID 39827080
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Home Antibiotic Use after Appendectomy for Complicated Appendicitis Does Not Influence Outcomes in Children Without Postoperative Signs of Infection: A NSQIP-P Observational Study
LIPPINCOTT WILLIAMS & WILKINS. 2024: S349-S350
View details for Web of Science ID 001348680702172
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The Optimal Age for Lobectomy of Congenital Pulmonary Airway Malformations in Infants: An Analysis of NSQIP-P Data
LIPPINCOTT WILLIAMS & WILKINS. 2024: S363
View details for Web of Science ID 001348680702199
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How Well Are We Preserving Ovaries in Children and Adolescents? Analysis of NSQIP-Pediatric Data
LIPPINCOTT WILLIAMS & WILKINS. 2024: S315-S316
View details for Web of Science ID 001348680702101
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Hepatic resections for pediatric hepatoblastoma: analysis of 30-day outcomes using the National Surgical Quality Improvement Program-Pediatric database.
Pediatric surgery international
2024; 40 (1): 230
Abstract
BACKGROUND: Surgical resection remains the cornerstone of treatment for hepatoblastoma in children and offers the best chance of disease-free survival. We aimed to analyze the 30day outcomes of hepatic resection for hepatoblastoma stratified by extent using the National Surgical Quality Improvement Program-Pediatric (NSQIP-P).METHODS: We queried NSQIP-P for children undergoing resection of Hepatoblastoma from 2012 to 2021. Relevant clinical characteristics and outcomes were extracted for multivariate logistic regression to identify predictors of common adverse outcomes.RESULTS: We included 458 children with a median age of 1.90years. Overall complications were rare, and perioperative blood transfusion (64.2%) and postoperative ventilation>48h (10.0%) were the only adverse events prevalent in more than 5% of patients. Median transfusion volume was 15.7ml/kg. On multivariate regression, only patients undergoing Trisectionectomy (aOR=3.387, 95% C.I.=1.348-8.510) had higher odds of receiving>75th percentile blood transfusion. Furthermore, only perioperative transfusion and postoperative ventilation>48h were statistically more common in patients undergoing extended versus standard resections.CONCLUSIONS: Outcomes following resection of hepatoblastoma are excellent, with low rates of postoperative adverse events. Although children undergoing trisectionectomy likely require greater transfusion volume, extended hepatic resections do not appear to have worse 30day outcomes despite greater operative complexity and duration.
View details for DOI 10.1007/s00383-024-05820-y
View details for PubMedID 39154089
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Pancreatic masses in children: a single-center experience over two decades.
European journal of pediatrics
2024
Abstract
Pancreatic masses are extremely rare in pediatric patients, with limited data available. This lack of data makes the diagnosis and management of these tumors in children extremely challenging. Therefore, we aimed to describe the presentations, clinical course, and outcomes of children with pancreatic tumors at our center. A retrospective analysis was performed of all pediatric patients diagnosed with pancreatic masses between 2003 and 2022 in an academic freestanding children's hospital. Data including demographics, clinical presentation, workup, management, and subsequent morbidity and mortality were collected and aggregated. Furthermore, we reviewed cases of pancreatic tumor resections in the National Surgical Quality Improvement Program - Pediatric (NSQIP-P) database to identify common adverse outcomes and measures for quality improvement. In total, 17 patients were identified at our institution. Diagnoses included solid pseudopapillary (n = 9), gastrinoma (n = 1), rhabdomyosarcoma (n = 2), pancreatoblastoma (n = 2), and insulinoma (n = 1). Two patients did not have a histopathologic diagnosis and were excluded from subsequent analysis. Overall, 12 patients underwent surgical intervention, with the most common procedures being pancreaticoduodenectomy and distal pancreatectomy, and all 12 were known to be alive at last contact. There were 3 deaths, all due to complications related to metastatic disease. Furthermore, 30-day postoperative outcomes in the NSQIP-P dataset for pancreatic surgeries in pediatric patients are excellent, with negligible morbidity and no mortalities after the index surgery.Children with pancreatic tumors amenable to surgical resection appear to have adequate long-term survival. Short-term outcomes at diagnosis are excellent and mainly appear to be influenced by the presence of metastatic disease at initial presentation.• Pancreatic masses are a rare entity in children with limited data on their presentation, management and surgical outcomes. • Solid Pseudopapillary tumors are one of the most common pancreatic tumors in children with a fair prognosis after surgical intervention.• Surgical management of pediatric patients with pancreatic tumors is safe and effective in patients who do not have aggressive tumor types or metastatic disease. • Our case series provides a notable cohort of these pancreatic tumors with insight into the presentation, management and outcomes of five of these tumor types.
View details for DOI 10.1007/s00431-024-05731-z
View details for PubMedID 39145888
View details for PubMedCentralID 10941481