Do New Technologies Produce the Best Surgical Outcomes for Children?

    • January 24, 2013

The Problem: Surgeons tend to use expensive new technologies without proof that they produce better outcomes than traditional methods, according to pediatric surgeon Brendan T. Campbell, MD, MPH. Could he apply health services research methods to help define what technologies and care do produce the best surgical results for children?

Grantee Background: Brendan T. Campbell, MD, MPH, grew up in Connecticut in a family where no one was interested in science, let alone medicine. “It’s hard to say exactly what pushed me in that direction. I was not the best student through high school. I was focused on athletics and other things,” he recalls. “In college, I realized that I had a wonderful opportunity to do whatever I wanted—and that, with focus and hard work, I could do well.” Campbell graduated from Trinity College in Hartford, Conn., in 1992. In 1997, he received his medical degree from the University of Connecticut School of Medicine in Farmington, and then headed south to the University of North Carolina (UNC) Hospitals at Chapel Hill for his surgical residency. Although nothing specifically drew Campbell to pediatric surgery, it did have its allure. “I found the challenges and demands of caring for patients with surgical problems appealing—and the instant gratification following a successful operation for a life-threatening condition to be very rewarding. Working with children and their parents is in some ways challenging,” he says, “but kids are more resilient than adults and they are a lot of fun to work with.”

Grantee Perspective: During Campbell’s surgical residency, George Sheldon, MD, the chairman of the department of surgery at UNC suggested he consider the Robert Wood Johnson Foundation Clinical Scholars program as it provided an avenue to study health services research and health policy. “At the University of Michigan, you had a lot of freedom to design a program consonant with your career goals,” he recalls. “There was enough structure so that you were able to learn the fundamentals of health services research and public health but you also had an opportunity to explore those areas that were most important to your interests.”

Campbell spent 2000 to 2002 as a Clinical Scholar at the University of Michigan Health System in Ann Arbor, earning a master’s degree in public health, and exploring his area of interest—quality of care in pediatric surgery. “ As I progressed through my years of training in adult and pediatric surgery, I began to realize that many of the things I was doing in the day-to-day care of surgical patients were not evidence-based. Surgeons have a tendency to utilize expensive new technologies without first proving that their use produces better results. A salient and current example of this would be the use of robotic surgery in pediatric patients. This technology adds significant cost above and beyond traditional minimally invasive surgery, with no proven benefit.

“Surgeons have been behind other physicians in critically evaluating their results. What I found is that there is an enormous opportunity to study certain types of issues related to quality of care in pediatric surgery. Do fellowship-trained pediatric surgeons have better outcomes than adult general surgeons when taking care of children with common surgical conditions? Do laparoscopic procedures produce better results than traditional open procedures? These seem like obvious questions, but few surgeons had evaluated these issues rigorously. It helped me realize the importance of looking at surgery from the population perspective rather than individual patient level.”

Results: Campbell’s most important work as a clinical scholar was on the surgical treatment of pyloric stenosis (a narrowing of the lower part of the stomach). Using administrative data from North Carolina, he demonstrated that pediatric surgeons have better results and fewer complications than adult general surgeons performing pyloromyotomies. “It’s not a novel concept, and it is consistent with what has been well described in adults,” he says.

A second study compared the laparoscopic and open approach to pyloromyotomy and showed that both approaches produced similar results, but the laparoscopic approach had an increased risk of rare, but serious complications and adversely affected the training of general surgery residents. Both of these studies were published in the Journal of Pediatric Surgery.

After completing the Clinical Scholars Program, Campbell returned to complete his general surgery training at UNC and went on to complete a pediatric surgery fellowship at Arkansas Children’s Hospital in Little Rock. In 2006, he came to Connecticut Children’s Medical Center in Hartford where he serves as the director of the Pediatric Trauma Program.

Of his nine years of surgical training, Campbell considers his two years as a Clinical Scholar to have been the most intellectually rewarding of his career. “The program gives you exposure to important aspects of health care beyond just clinical medicine,” he says. “ One of the challenging aspects of practicing medicine is that we are biased by our individual experiences. What I’ve found is that if you take a more global perspective, you can actually approach things in a more intellectually honest way.”

Campbell’s training in epidemiology and health policy while a Clinical Scholar was useful when he was appointed by Connecticut’s Governor to her Teen Driving Task Force in 2007. The Task Force provided evidence-based recommendations to the Legislature on how to improve Connecticut’s graduated driver’s licensing laws. The changes were passed by the Legislature and signed into law by Gov. M. Jodi Rell in April of 2008. Connecticut now has the most progressive teen driving laws in the nation. Campbell said, “This is a textbook example of how you can use epidemiologic research to guide important changes in public policy.”

During a February 2008 RWJF workshop called “Translating Research into Public Policy,” Campbell learned the importance of story-telling as a way to educate policy-makers and the media about your research. Shortly thereafter, he was contacted by the Hartford Courant to talk about teen driving. “I told the reporter almost verbatim the story I had used during the story-telling session of the workshop,” he recalls. “A few weeks later, my picture was on the front page, and leading into the article was the story I had developed at the workshop.”

RWJF Strategy: Originally authorized in 1972, the Robert Wood Johnson Foundation Clinical Scholars program is the oldest national program at RWJF. The program fosters the development of physicians who will lead the transformation of American health care. Former Clinical Scholars have become directors of federal, state and local health agencies and departments. Senior Program Officer J. A. Grisso, MD, MSc, who managed the program at RWJF, summed up the ideal Clinical Scholars candidate this way: “Someone with the passion to make a difference in health and health care, and the promise of being able to do it.”