Scholars@Duke
Harold Leraas

Harold Leraas

House Staff
Surgery

Selected Publications

Interfacility Transfer of Children With Time-Sensitive Surgical Conditions, 2002-2017.

Journal Article JAMA Netw Open · October 1, 2024 IMPORTANCE: Surgical care for children in the United States has become increasingly regionalized among fewer centers over time. The degree to which regionalization may be associated with access to urgent surgical care for time-sensitive conditions is not c ... Full text Link to item Cite

Firearm Ownership: A Key Factor to Consider in Firearm Suicide Deaths in Children, Despite State Gun Laws.

Journal Article J Surg Res · September 2024 INTRODUCTION: Firearm-related suicides among children present a significant public health concern and a tragic loss of young lives. This study explores the relationship between firearm-related suicides, gun ownership, and state-specific gun laws. METHODS: ... Full text Link to item Cite

Wilms tumor characteristics, surgical management, outcomes, and chronic kidney disease in children with WAGR syndrome: A report from the International WAGR Syndrome Association survey.

Journal Article Pediatr Blood Cancer · September 2024 INTRODUCTION: Children with WAGR (Wilms tumor, aniridia, genitourinary anomalies, and range of development delays) syndrome are predisposed to Wilms tumor (WT) and intrinsic kidney disease. Using the comprehensive International WAGR Syndrome Association (I ... Full text Link to item Cite

Roles, Responsibilities, and Expectations of Medical Students on Surgical Subinternships: A Modified Delphi Consensus Study.

Journal Article Acad Med · August 1, 2024 PURPOSE: Surgical subinternships are important rotations for students preparing for a career in general surgery; however, these rotations often vary by institution and service. This modified Delphi study was conducted to reach a consensus set of roles, res ... Full text Link to item Cite

Pediatric urothelial cancer: a cross-sectional descriptive analysis of the National Cancer Database.

Journal Article Transl Androl Urol · May 31, 2024 BACKGROUND: Urothelial cancer is a rare pediatric malignancy; previous analyses suggest lower rates of recurrence and death as compared to adults. We analyzed pediatric bladder cancer information in a national database, hypothesizing that survival would be ... Full text Link to item Cite

Who Benefits? An Assessment of Resident Benefits at Top 50 Academic Institutions.

Journal Article J Surg Educ · March 2024 OBJECTIVE: Residency serves as a crucial time in the professional and personal development of young physicians. Extensive effort is devoted to the clinical training of residents across the country. However, many residents report concerns with compensation, ... Full text Link to item Cite

Comparison of Outcomes Between Surveillance Ultrasound and Completion Lymph Node Dissection in Children and Adolescents With Sentinel Lymph Node-Positive Cutaneous Melanoma.

Conference Ann Surg · March 1, 2024 OBJECTIVE: To determine the impact of nodal basin ultrasound (US) surveillance versus completion lymph node dissection (CLND) in children and adolescents with sentinel lymph node (SLN) positive melanoma. BACKGROUND: Treatment for children and adolescents w ... Full text Link to item Cite

Longitudinal Integrated Clerkships and Undergraduate Surgical Education: A Scoping Review and Gap Analysis.

Journal Article J Surg Educ · March 2024 OBJECTIVE: Longitudinal integrated clerkships (LICs) are an increasingly popular approach to medical student clinical education, and the literature describing them is expanding. Despite this, there is a lack of understanding for how surgery didactics and s ... Full text Link to item Cite

Factors Associated with Discharge to Skilled Nursing Facility Following Gunshot Wounds.

Journal Article J Surg Res · February 2024 INTRODUCTION: Firearm injury is a public health crisis. Most victims are minorities in underserved neighborhoods. Measuring firearm injury by mortality underestimates its impact, as most victims survive to discharge. This study was done to determine if rac ... Full text Link to item Cite

The Use of Parenteral Nutrition and Disparities in Its Allocation Following Traumatic Injury.

Journal Article J Surg Res · January 2024 INTRODUCTION: Severe traumatic injury requires rapid and extensive deployment of resources to save the lives of the critically injured. The sequelae of traumatic injuries frequently require extensive intervention obligating patients to a complicated recove ... Full text Link to item Cite

Where Are the Children? A Thematic Analysis of State, Territory, and Tribal Organization Comprehensive Cancer Control Plans.

Journal Article J Pediatr Surg · January 2024 BACKGROUND: The Center for Disease Control's Comprehensive Cancer Control Program (CCCP) funds initiatives in fifty states, the District of Columbia, seven U.S. territories, and seven tribal organizations to prevent and control cancer. These initiatives in ... Full text Link to item Cite

Towards attainment of the 2030 goal for childhood cancer survival for the World Health Organization Global Initiative for Childhood Cancer: An ecological, cross-sectional study.

Journal Article PLOS Glob Public Health · 2024 The World Health Organization (WHO) recently launched the Global Initiative for Childhood Cancer (GICC), with the goal of attaining at least 60% cancer survival for children worldwide by the year 2030. This study aims to describe the global patterns of chi ... Full text Link to item Cite

Use of pediatric trauma simulations to facilitate exposure to pediatric trauma resuscitations during training.

Journal Article Surgery · December 2023 BACKGROUND: Pediatric traumas are often high-acuity but are low-frequency compared to adult trauma activations. This is reflected in the relatively limited experience with these events during training. Although some principles of trauma resuscitation are s ... Full text Link to item Cite

A National Comparison of Volume and Acuity for Adult and Pediatric Trauma: A Trauma Quality Improvement Program Cohort Study.

Journal Article J Surg Res · November 2023 INTRODUCTION: Most injured children receive trauma care outside of a pediatric trauma center. Differences in physiology, dosing, and injury pattern limit extrapolation of adult trauma principles to pediatrics. We compare US trauma center experience with pe ... Full text Link to item Cite

Using Crowdfunding Campaigns to Examine Financial Toxicity and Logistical Burdens Facing Families of Children With Wilms Tumor.

Journal Article J Surg Res · November 2023 INTRODUCTION: Treatment for pediatric solid tumors is often intense and multidisciplinary and can create a substantial financial burden for families. Assessing these burdens, termed the financial toxicity of treatment, can be difficult. Using Wilms tumor a ... Full text Link to item Cite

Predictors of 1-year enteral autonomy in children with intestinal failure: A descriptive retrospective cohort study.

Journal Article JPEN J Parenter Enteral Nutr · November 2023 INTRODUCTION: The International Intestinal Failure Registry (IIFR) is an international consortium to study intestinal failure (IF) outcomes in a large contemporary pediatric cohort. We aimed to identify predictors of early (1-year) enteral autonomy. METHOD ... Full text Link to item Cite

Revisiting Medical Student Expectations on the Surgery Clerkship.

Journal Article J Surg Educ · October 2023 OBJECTIVE: Medical students frequently report ambiguity of expectations in their feedback of the surgery clerkship. Herein, we aimed to gauge general surgery resident and attending expectations of students on their clerkship. DESIGN: Residents and attendin ... Full text Link to item Cite

Changing Landscape of Routine Pediatric Surgery for Rural and Urban Children: A Report From the Child Health Evaluation of Surgical Services (CHESS) Group.

Journal Article Ann Surg · October 1, 2023 OBJECTIVE: To describe the changes to routine pediatric surgical care over the past 2 decades for children living in urban and rural environments. BACKGROUND: A knowledge gaps exists regarding trends in the location where routine pediatric surgical care is ... Full text Link to item Cite

Change to Mixed-Lipid Emulsion From Soybean Oil-Based Lipid Emulsion in Pediatric Patients.

Journal Article JAMA Netw Open · September 5, 2023 IMPORTANCE: Critically ill pediatric patients often require parenteral nutrition (PN) in the intensive care unit (ICU). Literature suggests mixed lipid emulsions (LE) with soybean oil reduction strategies may improve outcomes. OBJECTIVE: To examine the ass ... Full text Open Access Link to item Cite

KeyLoop retractor for global gasless laparoscopy: evaluation of safety and feasibility in a porcine model.

Journal Article Surg Endosc · August 2023 BACKGROUND: Many surgeons in low- and middle-income countries have described performing surgery using gasless (lift) laparoscopy due to inaccessibility of carbon dioxide and reliable electricity, but the safety and feasibility of the technique has not been ... Full text Link to item Cite

Pediatric renal malignancy diagnosis is associated with significant burden of care for families.

Journal Article Pediatr Blood Cancer · June 19, 2023 BACKGROUND AND OBJECTIVES: New childhood cancer diagnoses require timely, complex care coordination and cause considerable logistic burden for families. We used renal tumors as a model to examine healthcare utilization and cost following new solid tumor di ... Full text Link to item Cite

Risk of Surgical Intervention in Children with Diagnoses of Cancer and Preoperative Malnutrition: A National Analysis.

Journal Article J Pediatr Surg · June 2023 BACKGROUND: Perioperative nutrition is a critical component of appropriate healing and recovery after surgery. We sought to identify perioperative risk in children with cancer and low preoperative hypoalbuminemia undergoing surgical intervention. METHODS: ... Full text Link to item Cite

The Surgical Subinternship: A Unique Opportunity for Early Leadership Development.

Journal Article J Surg Educ · June 2023 Subinternships are formative rotations in the surgery-bound medical student's journey to surgical training. This experience allows for further exploration of career goals, plays an important evaluative role in the residency selection process, and offers on ... Full text Link to item Cite

Low Cost Gastroschisis Silo for Sub-Saharan Africa: Testing in a Porcine Model.

Journal Article World J Surg · February 2023 BACKGROUND: Gastroschisis mortality in sub-Saharan Africa (SSA) remains high at 59-100%. Silo inaccessibility contributes to this disparity. Standard of care (SOC) silos cost $240, while median monthly incomes in SSA are < $200. Our multidisciplinary Ameri ... Full text Link to item Cite

Residents as a valuable asset: the financial benefits of residency program expansion

Journal Article Global Surgical Education - Journal of the Association for Surgical Education · January 23, 2023 Full text Cite

Improved survival and higher rates of surgical resection associated with hepatocellular carcinoma in children as compared to young adults.

Journal Article Int J Cancer · December 15, 2022 Hepatocellular adenocarcinoma (HCC) is the second most common primary hepatic malignancy in children with a 5-year overall survival of 30%. Few studies have examined the similarities and differences between pediatric and adult HCC. This article aims to exa ... Full text Link to item Cite

Coagulation Abnormalities and Clinical Complications in Children With SARS-CoV-2: A Systematic Review of 48,322 Patients.

Journal Article J Pediatr Hematol Oncol · August 1, 2022 Given the limited information on the coagulation abnormalities of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in pediatric patients, we designed a systematic review to evaluate this topic. A comprehensive literature search was conducted fo ... Full text Link to item Cite

Interhospital variability in localization techniques for small pulmonary nodules in children: A pediatric surgical oncology research collaborative study.

Journal Article J Pediatr Surg · June 2022 BACKGROUND: Pulmonary nodules that are deep within lung parenchyma and/or small in size can be challenging to localize for biopsy. This study describes current trends in performance of image-guided localization techniques for pulmonary nodules in pediatric ... Full text Link to item Cite

Surgical Site Infection in Children with Neuromuscular Disorders after Laparoscopic Gastrostomy: A Propensity-Matched National Surgical Quality Improvement Program Pediatrics Database Analysis.

Journal Article Surg Infect (Larchmt) · April 2022 Background: Prior studies have demonstrated that children with neuromuscular scoliosis have a higher incidence of infection after spine surgery. The purpose of the study is to determine whether children with neuromuscular disorders (NMDs) have higher rate ... Full text Link to item Cite

Use of a Structured Observation Tool to Promote Medical Student Engagement in Trauma Resuscitations.

Journal Article J Surg Educ · 2022 OBJECTIVE: We describe a novel approach to promoting medical student learning and engagement during trauma resuscitation with implementation of a structured observation and debriefing tool. DESIGN: In the context of a multifaceted quality improvement effor ... Full text Link to item Cite

Non-inferiority of fragmented care for high-risk pediatric neuroblastoma patients: a single institution analysis.

Journal Article Pediatr Hematol Oncol · November 2021 Pediatric neuroblastoma (NB) patients receive multi-modal therapy and may experience care fragmented among multiple institutions with a significant travel burden, which has been associated with poor outcomes for some adult cancers. We hypothesized that fra ... Full text Link to item Cite

Hepatic vascular malignancies in children are associated with increased rates of surgical resection and improved overall survival compared with adults.

Journal Article Pediatr Blood Cancer · May 2021 BACKGROUND: Hepatic vascular malignancies (HVMs) are rare malignancies, with no standardized treatment regimens. The most common HVMs, angiosarcoma and malignant epithelioid hemangioendothelioma (EHE), are often grouped together in the literature complicat ... Full text Link to item Cite

Pancreaticoduodenectomy for the treatment of pancreatic neoplasms in children: A Pediatric Surgical Oncology Research Collaborative study.

Journal Article Pediatr Blood Cancer · September 2020 BACKGROUND: To better characterize short-term and long-term outcomes in children with pancreatic tumors treated with pancreaticoduodenectomy (PD). METHODS: Patients 21 years of age or younger who underwent PD at Pediatric Surgical Oncology Collaborative (P ... Full text Link to item Cite

Medical Student Involvement and Learning Objectives in Morbidity and Mortality Conferences: A National Survey of the Association for Surgical Education's Committee of Clerkship Directors.

Journal Article J Surg Educ · 2020 BACKGROUND: Despite implementation of Morbidity and Mortality (M&M) Conference across surgical graduate medical education, sparse literature exists regarding the attendance and involvement of medical students. We sought to examine student involvement and l ... Full text Link to item Cite

Cervical seatbelt sign is not associated with blunt cerebrovascular injury in children: A review of the national trauma databank.

Journal Article Am J Surg · July 2019 BACKGROUND: Blunt cerebrovascular injury (BCVI) is a rare consequence of blunt trauma. There appears to be benefit to an aggressive approach to screening for BCVI due to catastrophic sequelae of unrecognized injury. However, screening for BCVI carries exte ... Full text Link to item Cite

Higher mortality in pediatric and adult trauma patients with traumatic coagulopathy, using age-adjusted diagnostic criteria.

Journal Article Surgery · June 2019 BACKGROUND: Acute traumatic coagulopathy has been described in adult trauma patients. Acute traumatic coagulopathy may be associated with higher mortality and morbidity in pediatric trauma patients. We aimed to (1) compare acute traumatic coagulopathy inci ... Full text Link to item Cite

Massive transfusion in the pediatric population: A systematic review and summary of best-evidence practice strategies.

Journal Article J Trauma Acute Care Surg · April 2019 BACKGROUND: Pediatric patients require massive transfusion (MT) in a variety of settings. Multiple studies of adult MT support balanced ratio transfusion to improve outcomes; however, it is unclear if these findings can be extrapolated to pediatric populat ... Full text Link to item Cite

Outcomes of laparoscopic resection of Meckel's diverticulum are equivalent to open laparotomy.

Journal Article J Pediatr Surg · March 2019 PURPOSE: Meckel's diverticulum (MD) is a common congenital anomaly caused by failure of involution of the omphalomesenteric duct. Enthusiasm for minimally invasive surgery (MIS) in children has burgeoned as technologies have advanced, but the outcomes of l ... Full text Link to item Cite

Routine postprocedure ultrasound increases rate of detection of femoral arterial thrombosis in infants after cardiac catheterization.

Journal Article Catheter Cardiovasc Interv · March 1, 2019 OBJECTIVES: To examine the effect of implementing postcatheterization ultrasound (US) on femoral arterial thrombosis detection rates and factors associated with thrombosis in infants. BACKGROUND: Although femoral arterial thrombosis is an uncommon complica ... Full text Link to item Cite

Health Career Academy: Addition of a Surgical Case-Based Learning Curriculum Captures the Interest of High School Students.

Journal Article J Surg Educ · 2019 OBJECTIVE: The Health Career Academy (HCA) is a national program which provides a structure to introduce underserved high school students to healthcare careers. Utilizing the HCA framework, we adapted the curriculum to emphasize surgical cases and invited ... Full text Link to item Cite

Improved contemporary outcomes of liver transplantation for pediatric hepatoblastoma and hepatocellular carcinoma.

Journal Article Pediatr Transplant · December 2018 PURPOSE: Improvement in outcomes of LT for pediatric HB and HCC has been reported in small series. We analyzed national outcomes and changes in donor, recipient, and perioperative factors over time that may contribute to survival differences. METHODS: The ... Full text Link to item Cite

Local excision results in comparable survival to radical resection for early-stage rectal carcinoid.

Journal Article J Surg Res · October 2018 BACKGROUND: Controversy exists regarding current National Comprehensive Cancer Network guidelines, which recommend local excision for rectal carcinoids ≤2 cm and radical resection for tumors >2 cm. Given the limited data examining optimal surgical approach ... Full text Link to item Cite

Pediatric phyllodes tumors: A review of the National Cancer Data Base and adherence to NCCN guidelines for phyllodes tumor treatment.

Journal Article J Pediatr Surg · June 2018 BACKGROUND: Phyllodes tumors are fibroepithelial breast lesions that are uncommon in women and rare among children. Due to scarcity, few large pediatric phyllodes tumor series exist. Current guidelines do not differentiate treatment recommendations between ... Full text Link to item Cite

Solid Pseudopapillary Neoplasm of the Pancreas in Children and Adults: A National Study of 369 Patients.

Journal Article J Pediatr Hematol Oncol · May 2018 BACKGROUND: Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare tumor in children, with current evidence limited to single-center studies. We examined treatment and clinical outcomes for pediatric and adult SPN with a national data set. METHODS: ... Full text Link to item Cite

Low mortality rates after endovascular aortic repair expand use to high-risk patients.

Journal Article J Vasc Surg · February 2018 OBJECTIVE: The 2010 endovascular aneurysm repair (EVAR) trial 2 (EVAR 2) reported that patients with comorbidity profiles rendering them unfit for open aneurysm repair who underwent EVAR did not experience a survival advantage compared with those who did n ... Full text Link to item Cite

Instituting a Surgical Skills Competition Increases Technical Performance of Surgical Clerkship Students Over Time.

Journal Article J Surg Educ · 2018 INTRODUCTION: Surgical skills training varies greatly between institutions and is often left to students to approach independently. Although many studies have examined single interventions of skills training, no data currently exists about the implementati ... Full text Link to item Cite

Renal medullary carcinoma: A national analysis of 159 patients.

Journal Article Pediatr Blood Cancer · November 2017 BACKGROUND: Renal medullary carcinoma (RMC) is an aggressive malignancy seen predominantly in young males with sickle cell trait. RMC is poorly understood, with fewer than 220 cases described in the medical literature to date. We used a large national regi ... Full text Link to item Cite

Outcomes following elective resection of congenital pulmonary airway malformations are equivalent after 3 months of age and a weight of 5 kg.

Journal Article J Pediatr Surg · October 9, 2017 PURPOSE: Resection of congenital pulmonary airway malformations (CPAMs) is often performed to reduce the risk of recurrent infection and malignant transformation. However, there is substantial variation in the timing of resection. This study was performed ... Full text Link to item Cite

Children Receiving Hematopoietic Stem Cell Transplantation are at Increased Risk of Onychocryptosis Requiring Surgical Management.

Journal Article J Pediatr Hematol Oncol · October 2017 PURPOSE: At our institution, a high proportion of children with onychocryptosis (ingrown toenail) requiring surgical intervention were noted to have a history of hematopoietic stem cell transplantation (HSCT). We analyzed the characteristics of patients wh ... Full text Link to item Cite

Hand-Assisted Laparoscopic Colectomy Improves Perioperative Outcomes Without Increasing Operative Time Compared to the Open Approach: a National Analysis of 8791 Patients.

Journal Article J Gastrointest Surg · April 2017 INTRODUCTION: Hand-assisted laparoscopic surgery (HALS) is often used in procedures too complex for completely minimally invasive approaches. However, there are concerns for whether this hybrid approach abrogates perioperative benefits of the completely mi ... Full text Link to item Cite

Morbidity and healthcare costs of vascular anomalies: a national study.

Journal Article Pediatr Surg Int · February 2017 PURPOSE: This study aimed to define morbidities and costs related to modern-day medical care for children with vascular anomalies. METHODS: We reviewed the 2003-2009 Kids' Inpatient Database for pediatric patients (age < 21 years) hospitalized with hemangi ... Full text Link to item Cite

Onychocryptosis in the Pediatric Patient.

Journal Article Clin Pediatr (Phila) · February 2017 Full text Link to item Cite

Could the Use of an Enhanced Recovery Protocol in Laparoscopic Donor Nephrectomy be an Incentive for Live Kidney Donation?

Journal Article Cureus · November 22, 2016 INTRODUCTION AND BACKGROUND: Gastrointestinal (GI) recovery after major abdominal surgery can be delayed from an ongoing need for narcotic analgesia thereby prolonging hospitalization. Enhanced recovery after surgery (ERAS) is a multimodal perioperative ca ... Full text Open Access Link to item Cite