Scholars@Duke
Ryan M Antiel

Ryan M Antiel

Assistant Professor of Surgery
Surgery, Pediatric General Surgery
ryan.antiel@duke.edu
DUMC 3815, Durham, NC 27710
2301 Erwin Road - Rm 6680 Hafs, Durham, NC 27710

Selected Publications

Biliary atresia in Uganda: Current ethical challenges and advancement of public policy.

Journal Article World J Surg · October 2024 Biliary atresia is a progressive cholangiopathy in neonates, which often results in liver failure. In high-income countries, initial treatment requires prompt diagnosis followed by Kasai portoenterostomy. For those with a late diagnosis, or those in whom K ... Full text Link to item Cite

Contemporary trends in choledochal cyst excision: An analysis of the pediatric national surgical quality improvement program.

Journal Article World J Surg · April 2024 BACKGROUND: Choledochal cysts are rare congenital anomalies of the biliary tree that may lead to obstruction, chronic inflammation, infection, and malignancy. There is wide variation in the timing of resection, operative approach, and reconstructive techni ... Full text Link to item Cite

The Rise and Fall of Medical School Rankings.

Journal Article Acad Med · November 1, 2023 Full text Link to item Cite

Maternal-fetal surgery as part of pediatric palliative care.

Journal Article Semin Fetal Neonatal Med · June 2023 Maternal-fetal surgical interventions have become a more common part of prenatal care. This third option, beside termination or post-natal interventions, complicates prenatal decision-making: while interventions may be lifesaving, survivors may face a life ... Full text Link to item Cite

Impact of COVID-19 on Admissions and Outcomes for Children With Complex Chronic Conditions.

Journal Article Hosp Pediatr · April 1, 2022 BACKGROUND: Although pediatric health care use declined during the coronavirus disease 2019 (COVID-19) pandemic, the impact on children with complex chronic conditions (CCCs) has not been well reported. OBJECTIVE: To describe the impact of the pandemic on ... Full text Link to item Cite

Surgical Interventions During End-of-Life Hospitalizations in Children's Hospitals.

Journal Article Pediatrics · December 1, 2021 OBJECTIVES: To characterize patterns of surgery among pediatric patients during terminal hospitalizations in children's hospitals. METHODS: We reviewed patients ≤20 years of age who died among 4 424 886 hospitalizations from January 2013-December 2019 with ... Full text Link to item Cite

Omental cyst: a case report and review of the literature

Journal Article Annals of Pediatric Surgery · December 1, 2021 Background: Omental cysts are rare, predominantly occur in children, and often initially present with symptoms masquerading as other more common intra-abdominal pathologies. In this case report, we present the case of a child with an omental cyst that orig ... Full text Cite

Ethics in prenatal consultation for surgically correctable anomalies and fetal intervention.

Journal Article Semin Pediatr Surg · October 2021 Pediatric surgeons play an essential role in prenatal consultation for congenital anomalies likely to require surgery in the newborn period. The involvement of pediatric surgeons during multi-disciplinary prenatal meetings has been an important part of the ... Full text Link to item Cite

Inpatient Use and Outcomes at Children's Hospitals During the Early COVID-19 Pandemic.

Journal Article Pediatrics · June 2021 BACKGROUND AND OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has led to changes in health care use, including decreased emergency department visits for children. In this study, we sought to describe the impact of the COVID-19 pandemic on inp ... Full text Link to item Cite

Extracorporeal Membrane Oxygenation for Pediatric Patients With Coronavirus Disease 2019-Related Illness.

Journal Article Pediatr Crit Care Med · October 2020 OBJECTIVE: To describe current hospital guidelines and the opinions of extracorporeal membrane oxygenation leaders at U.S. children's hospitals concerning the use of extracorporeal membrane oxygenation for coronavirus disease 2019-positive pediatric patien ... Full text Link to item Cite

Should Pediatric Patients Be Prioritized When Rationing Life-Saving Treatments During COVID-19 Pandemic.

Journal Article Pediatrics · September 2020 Coronavirus disease 2019 can lead to respiratory failure. Some patients require extracorporeal membrane oxygenation support. During the current pandemic, health care resources in some cities have been overwhelmed, and doctors have faced complex decisions a ... Full text Link to item Cite

Pouchogram Prior to Ileostomy Reversal after Ileal Pouch-Anal Anastomosis in Pediatric Patients: Is it Useful in the Setting of Routine EUA?

Journal Article J Pediatr Surg · August 2020 PURPOSE: To determine if there is a role for routine pouchogram before ileostomy reversal after IPAA in pediatric patients. METHODS: The medical records of pediatric patients who underwent pouchogram between 2007 and 2017 prior to ileostomy reversal after ... Full text Link to item Cite

Responsibilities, Strategies, and Practice Factors in Clinical Cost Conversations: a US Physician Survey.

Journal Article J Gen Intern Med · July 2020 BACKGROUND: Physicians play a key role in mitigating and managing costs in healthcare which are rising. OBJECTIVE: Conduct a cross-sectional survey in 2017, comparing results to a 2012 survey to understand US physicians' evolving attitudes and strategies c ... Full text Link to item Cite

Parental Attitudes Towards Prenatal Genetic Testing For Sickle Cell Disease.

Journal Article J Pediatr Hematol Oncol · November 2019 Uptake of prenatal genetic testing (PGT) is low among those with sickle cell disease (SCD). This study evaluated the association of knowledge and attitudes towards prenatal genetic counseling (PGC), awareness of posttesting intervention options and omissio ... Full text Link to item Cite

Pediatric neurosurgeons' views regarding prenatal surgery for myelomeningocele and the management of hydrocephalus: a national survey.

Journal Article Neurosurg Focus · October 1, 2019 OBJECTIVE: The Management of Myelomeningocele Study (MOMS) compared prenatal with postnatal surgery for myelomeningocele (MMC). The present study sought to determine how MOMS influenced the clinical recommendations of pediatric neurosurgeons, how surgeons' ... Full text Link to item Cite

US Physicians' Reactions To ACA Implementation, 2012-17.

Journal Article Health Aff (Millwood) · September 2019 Physicians play a key role in implementing health policy, and US physicians were split in their opinions about the Affordable Care Act (ACA) soon after its implementation began. We readministered elements of a prior survey of US physicians to a similar sam ... Full text Link to item Cite

Pediatric Perioperative DNR Orders: A Case Series in a Children's Hospital.

Journal Article J Pain Symptom Manage · May 2019 CONTEXT: Do-not-resuscitate (DNR) orders are common among children receiving palliative care, who may nevertheless benefit from surgery and other procedures. Although anesthesia, surgery, and pediatric guidelines recommend systematic reconsideration of DNR ... Full text Link to item Cite

Reduced oxygen concentration for the resuscitation of infants with congenital diaphragmatic hernia.

Journal Article J Perinatol · July 2018 OBJECTIVE: To evaluate whether infants with congenital diaphragmatic hernia (CDH) can be safely resuscitated with a reduced starting fraction of inspired oxygen (FiO2) of 0.5. STUDY DESIGN: A retrospective cohort study comparing 68 patients resuscitated wi ... Full text Link to item Cite

Attitudes of paediatric and obstetric specialists towards prenatal surgery for lethal and non-lethal conditions.

Journal Article J Med Ethics · April 2018 BACKGROUND: While prenatal surgery historically was performed exclusively for lethal conditions, today intrauterine surgery is also performed to decrease postnatal disabilities for non-lethal conditions. We sought to describe physicians' attitudes about pr ... Full text Link to item Cite

Definitive airway management after prehospital supraglottic rescue airway in pediatric trauma.

Journal Article J Pediatr Surg · February 2018 INTRODUCTION: Supraglottic airway (SGA) use and outcomes in pediatric trauma are poorly understood. We compared outcomes between patients receiving prehospital SGA versus bag mask ventilation (BVM). METHODS: We reviewed pediatric multisystem trauma patient ... Full text Link to item Cite

The experience of parents with children with myelomeningocele who underwent prenatal surgery.

Journal Article J Pediatr Rehabil Med · 2018 BACKGROUND: Prenatal surgery for myelomeningocele (MMC) has been demonstrated to have benefits over postnatal surgery. Nevertheless, prenatal surgery requires a significant emotional, physical, and financial commitment from the entire family. METHODS: Mixe ... Full text Link to item Cite

Weighing the Social and Ethical Considerations of Maternal-Fetal Surgery.

Journal Article Pediatrics · December 2017 OBJECTIVES: The ethics of maternal-fetal surgery involves weighing the importance of potential benefits, risks, and other consequences involving the pregnant woman, fetus, and other family members. We assessed clinicians' ratings of the importance of 9 con ... Full text Link to item Cite

Responsible surgical innovation and research in maternal-fetal surgery.

Journal Article Semin Fetal Neonatal Med · December 2017 The field of maternal-fetal intervention is rapidly evolving with new technologies and innovations. This raises complex ethical and medico-legal challenges related to what constitutes innovative treatment versus human experimentation, with or without the u ... Full text Link to item Cite

Growth trajectory and neurodevelopmental outcome in infants with congenital diaphragmatic hernia.

Journal Article J Pediatr Surg · December 2017 PURPOSE: The purpose of this study was to evaluate the impact of impaired growth on short-term neurodevelopmental (ND) outcomes in CDH survivors. METHODS: Between 9/2005-12/2014, 84 of 215 (39%) CDH survivors underwent ND assessment at 12months of age usin ... Full text Link to item Cite

Acceptability of In Utero Hematopoietic Cell Transplantation for Sickle Cell Disease.

Journal Article Med Decis Making · November 2017 BACKGROUND: In utero hematopoietic cell transplantation (IUHCT) has curative potential for sickle cell disease (SCD) but carries a risk of fetal demise. METHODS: We assessed the conditions under which parents of children with SCD and young adults with SCD ... Full text Link to item Cite

Parental Perceptions of Pediatric Pain and POTS-Related Disability.

Journal Article Clin Pediatr (Phila) · November 2017 Adolescents with postural orthostatic tachycardia syndrome (POTS) often have pain and functional impairment. This study evaluated how parental attributions of children's symptoms relate to child functional impairment. Adolescents with chronic pain and clin ... Full text Link to item Cite

Physician views regarding the benefits and burdens of prenatal surgery for myelomeningocele.

Journal Article J Perinatol · September 2017 OBJECTIVE: Examine how pediatric and obstetrical subspecialists view benefits and burdens of prenatal myelomeningocele (MMC) closure. STUDY DESIGN: Mail survey of 1200 neonatologists, pediatric surgeons and maternal-fetal medicine specialists (MFMs). RESUL ... Full text Link to item Cite

Swallowing Dysfunction and Quality of Life in Adults With Surgically Corrected Esophageal Atresia/Tracheoesophageal Fistula as Infants: Forty Years of Follow-up.

Journal Article Ann Surg · August 2017 OBJECTIVES: The aim of the study was to evaluate and study the full spectrum of swallowing dysfunction and long-term disease-specific outcomes in adults with surgically corrected esophageal atresia/tracheaesophageal fistula (EA/TEF). BACKGROUND: Long-term ... Full text Link to item Cite

Neurodevelopmental outcomes at 5years of age in congenital diaphragmatic hernia.

Journal Article J Pediatr Surg · March 2017 OBJECTIVE: To evaluate neurodevelopmental sequelae in congenital diaphragmatic hernia (CDH) children at 5years of age. MATERIALS AND METHODS: The study cohort of 35 CDH patients was enrolled in our follow-up program between 06/2004 and 09/2014. The neurode ... Full text Link to item Cite

Specialty-Based Variation in Applying Maternal-Fetal Surgery Trial Evidence.

Journal Article Fetal Diagn Ther · 2017 INTRODUCTION: The Management of Myelomeningocele Study (MOMS) compared prenatal with postnatal surgery for fetal myelomeningocele (MMC). We sought to understand how subspecialists interpreted the trial results and whether their practice has changed. MATERI ... Full text Link to item Cite

Management and outcomes of scoliosis in children with congenital diaphragmatic hernia.

Journal Article J Pediatr Surg · December 2016 PURPOSE: The purpose of this study was to evaluate the management and outcomes of CDH patients with scoliosis. METHODS: From January 1996 to August 2015, 26 of 380 (7%) CDH patients were diagnosed with scoliosis. Six (23%) were prenatally diagnosed by ultr ... Full text Link to item Cite

Mitral Valve Prolapse, Psychoemotional Status, and Quality of Life: Prospective Investigation in the Current Era.

Journal Article Am J Med · October 2016 OBJECTIVE: The purpose of this study is to investigate whether mitral valve prolapse is associated with the patient's psychoemotional status and health-related quality of life. METHODS: Mitral valve prolapse and mitral regurgitation were prospectively and ... Full text Link to item Cite

Impact on family and parental stress of prenatal vs postnatal repair of myelomeningocele.

Journal Article Am J Obstet Gynecol · October 2016 BACKGROUND: The Management of Myelomeningocele Study was a multicenter, randomized controlled trial that compared prenatal repair with standard postnatal repair for fetal myelomeningocele. OBJECTIVE: We sought to describe the long-term impact on the famili ... Full text Link to item Cite

Patient-Reported Outcomes after Laparoscopic Ventral Hernia Repair.

Journal Article Am Surg · June 2016 Approximately 350,000 ventral hernia repairs are performed in the United States each year. Patients expect fast recovery after laparoscopic ventral hernia repair (LVHR) and undisturbed postoperative quality of life (QOL). We examined the utility of a brief ... Link to item Cite

Ethical challenges in the new world of maternal-fetal surgery.

Journal Article Semin Perinatol · June 2016 This article explores some of the complex ethical challenges that exist in the field of fetal diagnosis and treatment, especially surrounding maternal-fetal surgery. The rise of these new treatments force us to reconsider who or what is the fetus, what are ... Full text Link to item Cite

When a Surgical Colleague Makes an Error.

Journal Article Pediatrics · March 2016 Professionalism requires that doctors acknowledge their errors and figure out how to avoid making similar ones in the future. Over the last few decades, doctors have gotten better at acknowledging mistakes and apologizing to patients when a mistake happens ... Full text Link to item Cite

Pretransfer computed tomography delays arrival to definitive care without affecting pediatric trauma outcomes.

Journal Article J Pediatr Surg · February 2016 PURPOSE: Children with thoracic or abdominal trauma, presenting to referring hospitals, may undergo CT imaging prior to transfer to a pediatric trauma center (PTC). We sought to determine if children who undergo pretransfer imaging experience a delay in de ... Full text Link to item Cite

Quality of life after videoscopic left cardiac sympathetic denervation in patients with potentially life-threatening cardiac channelopathies/cardiomyopathies.

Journal Article Heart Rhythm · January 2016 BACKGROUND: Left cardiac sympathetic denervation (LCSD) provides an additive or potentially alternative treatment option for patients with life-threatening cardiac channelopathies/cardiomyopathies. OBJECTIVE: We sought to examine the effects of LCSD on qua ... Full text Link to item Cite

Medical Students' Views and Knowledge of the Affordable Care Act: A Survey of Eight U.S. Medical Schools.

Journal Article J Gen Intern Med · July 2015 BACKGROUND: It is not known whether medical students support the Affordable Care Act (ACA) or possess the knowledge or will to engage in its implementation as part of their professional obligations. OBJECTIVE: To characterize medical students' views and kn ... Full text Link to item Cite

Two infants, same prognosis, different parental preferences.

Journal Article Pediatrics · May 2015 A central principle of justice is that similar cases should be decided in similar ways. In pediatrics, however, there are cases in which 2 infants have similar diagnoses and prognoses, but their parents request different treatments. In this Ethics Rounds, ... Full text Link to item Cite

Psychoemotional and quality of life response to mitral operations in patients with mitral regurgitation: a prospective study.

Journal Article Ann Thorac Surg · March 2015 BACKGROUND: Severe mitral regurgitation (MR) is associated with frequent alteration of psychoemotional status (PES), with anxiety and stress symptoms related to health-related quality of life (HR-QOL). Yet, it is unknown whether surgical correction of MR l ... Full text Link to item Cite

Spanning our differences: moral psychology, physician beliefs, and the practice of medicine.

Journal Article Philos Ethics Humanit Med · November 4, 2014 Moral pluralism is the norm in contemporary society. Even the best philosophical arguments rarely persuade moral opponents who differ at a foundational level. This has been vividly illustrated in contemporary debates in bioethics surrounding contentious is ... Full text Link to item Cite

Should age be a basis for rationing health care?

Journal Article Virtual Mentor · May 1, 2014 Full text Link to item Cite

Intra-abdominal venous thrombosis after colectomy in pediatric patients with chronic ulcerative colitis: incidence, treatment, and outcomes.

Journal Article J Pediatr Surg · April 2014 PURPOSE: Children with chronic ulcerative colitis (CUC) are at increased risk for venous thromboembolism, especially after colectomy procedures. We aim to review our patients with CUC who underwent a colectomy and suffered intra-abdominal thrombosis; moreo ... Full text Link to item Cite

Pediatric median arcuate ligament syndrome: surgical outcomes and quality of life.

Journal Article J Laparoendosc Adv Surg Tech A · February 2014 BACKGROUND: The existence, etiology, diagnosis, and treatment of median arcuate ligament syndrome (MALS) have long been subjects of debate. To our knowledge, there have not been any studies assessing the effectiveness of surgical treatment in improving phy ... Full text Link to item Cite

Physician opinion and the HHS contraceptives mandate

Journal Article AJOB Empirical Bioethics · January 1, 2014 Background: The Health and Human Services (HHS) contraceptives mandate, recommended on the advice of the Institute of Medicine (IOM), has evoked a heated debate about whether religiously affiliated organizations should be required to provide contraceptive ... Full text Cite

Should age be a basis for rationing health care? Commentary 1

Journal Article Virtual Mentor · January 1, 2014 Full text Cite

Psycho-emotional manifestations of valvular heart diseases: prospective assessment in mitral regurgitation.

Journal Article Am J Med · October 2013 OBJECTIVE: To define the prevalence and consequences of post-traumatic stress disorder (PTSD) as an emotional response to cardiac diseases in patients with mitral regurgitation. METHODS: We prospectively enrolled 186 patients with moderate or severe organi ... Full text Link to item Cite

The moral psychology of rationing among physicians: the role of harm and fairness intuitions in physician objections to cost-effectiveness and cost-containment.

Journal Article Philos Ethics Humanit Med · September 8, 2013 INTRODUCTION: Physicians vary in their moral judgments about health care costs. Social intuitionism posits that moral judgments arise from gut instincts, called "moral foundations." The objective of this study was to determine if "harm" and "fairness" intu ... Full text Link to item Cite

Muscle spasms after thyroidectomy: What went wrong?

Journal Article World Journal of Endocrine Surgery · July 9, 2013 Postoperative complications of thyroid surgery are generally limited, though not entirely rare. Cervical hematoma, recurrent laryngeal nerve damage and hypoparathyroidism are of greatest concern, with the latter being the most frequently encountered. We re ... Full text Cite

Professionalism: etiquette or habitus?

Journal Article Mayo Clin Proc · July 2013 Full text Link to item Cite

Specialty, Political Affiliation, and Perceived Social Responsibility Are Associated with U.S. Physician Reactions to Health Care Reform Legislation.

Journal Article J Gen Intern Med · June 25, 2013 BACKGROUND: Little is known about how U.S. physicians' political affiliations, specialties, or sense of social responsibility relate to their reactions to health care reform legislation. OBJECTIVE: To assess U.S. physicians' impressions about the direction ... Full text Link to item Cite

Effects of duty hour restrictions on core competencies, education, quality of life, and burnout among general surgery interns.

Journal Article JAMA Surg · May 2013 OBJECTIVE: To measure the implications of the new Accreditation Council for Graduate Medical Education duty hour regulations for education, well-being, and burnout. DESIGN: Longitudinal study. SETTING: Eleven university-based general surgery residency prog ... Full text Link to item Cite

"Righteous minds" in health care: measurement and explanatory value of social intuitionism in accounting for the moral judgments in a sample of U.S. physicians.

Journal Article PLoS One · 2013 The broad diversity in physicians' judgments on controversial health care topics may reflect differences in religious characteristics, political ideologies, and moral intuitions. We tested an existing measure of moral intuitions in a new population (U.S. p ... Full text Link to item Cite

PREDICTORS OF US PHYSICIAN REACTIONS TO THE AFFORDABLE CARE ACT

Conference JOURNAL OF GENERAL INTERNAL MEDICINE · 2013 Cite

Dignity in end-of-life care: results of a national survey of U.S. physicians.

Journal Article J Pain Symptom Manage · September 2012 CONTEXT: Debates persist about the relevance of "dignity" as an ethical concept in U.S. health care, especially in end-of-life care. OBJECTIVES: To describe the attitudes and beliefs regarding the usefulness and meaning of the concept of dignity and to exa ... Full text Link to item Cite

Surgical training, duty-hour restrictions, and implications for meeting the Accreditation Council for Graduate Medical Education core competencies: views of surgical interns compared with program directors.

Journal Article Arch Surg · June 2012 OBJECTIVE: To describe the perspectives of surgical interns regarding the implications of the new Accreditation Council for Graduate Medical Education (ACGME) duty-hour regulations for their training. DESIGN: We compared responses of interns and surgery pr ... Full text Link to item Cite

Quality of life after early mitral valve repair using conventional and robotic approaches.

Journal Article Ann Thorac Surg · March 2012 BACKGROUND: Early mitral valve (MV) repair of degenerative mitral regurgitation is associated with superior clinical outcomes compared with prosthetic replacement and restores normal life expectancy, even in those without symptoms. Although current guideli ... Full text Link to item Cite

Attracting students to surgical careers: preclinical surgical experience.

Journal Article J Surg Educ · 2012 OBJECTIVES: Along with a decline in interest in general surgery among United States medical school graduates, reports indicate a decrease in the amount of time students are spending on their surgical clerkship. In an effort to offer early exposure to gener ... Full text Link to item Cite

Whose best interest?

Journal Article Minn Med · December 2011 In the summer of 1910, William James Mayo, M.D., delivered the commencement address at Rush Medical College in Chicago. In his speech, he uttered words that have become the cornerstone of Mayo Clinic's model of care: "The best interest of the patient is th ... Link to item Cite

A like sufferer.

Journal Article J Palliat Med · October 2011 Full text Link to item Cite

Iron insufficiency and hypovitaminosis D in adolescents with chronic fatigue and orthostatic intolerance.

Journal Article South Med J · August 2011 OBJECTIVES: More than 10% of adolescents suffer from severe fatigue and/or orthostatic intolerance. Adult studies show correlations between iron insufficiency and fatigue as well as between hypovitaminosis D and non-specific pain. We sought to determine wh ... Full text Link to item Cite

Conscientious refusals to refer: findings from a national physician survey.

Journal Article J Med Ethics · July 2011 BACKGROUND: Regarding controversial medical services, many have argued that if physicians cannot in good conscience provide a legal medical intervention for which a patient is a candidate, they should refer the requesting patient to an accommodating provid ... Full text Link to item Cite

Functional disability in adolescents with orthostatic intolerance and chronic pain.

Journal Article J Child Neurol · May 2011 A retrospective review identified 99 adolescents (79% female) referred to a tertiary care center to evaluate the relationship between symptoms of orthostatic intolerance and chronic pain. Regression analysis indicated that functional disability was strongl ... Full text Link to item Cite

Duty hour recommendations and implications for meeting the ACGME core competencies: views of residency directors.

Journal Article Mayo Clin Proc · March 2011 OBJECTIVE: To describe the views of residency program directors regarding the effect of the 2010 duty hour recommendations on the 6 core competencies of graduate medical education. METHODS: US residency program directors in internal medicine, pediatrics, a ... Full text Link to item Cite

Inconclusive findings on effects of duty hour reduction: Reply-I

Journal Article Mayo Clinic Proceedings · January 1, 2011 Full text Cite

Ethics in everyday pediatrics.

Journal Article J Pediatr · June 2009 Full text Link to item Cite

Orthostatic intolerance and gastrointestinal motility in adolescents with nausea and abdominal pain.

Journal Article J Pediatr Gastroenterol Nutr · March 2008 OBJECTIVE: To describe the relationships between gastric emptying, autonomic function, and postural tachycardia in adolescent patients with nausea and/or abdominal discomfort. It was hypothesized that patients with both gastrointestinal symptoms and sympto ... Full text Link to item Cite