Pediatric Surgery Research

Jump to: Kenneth Azarow, M.D. | Katherine Ballard, D.N.P., CPNP-AC/PC | Benjamin Carr, M.D. | Elizabeth Fialkowski, M.D. | Mubeen A. Jafri, M.D., FACS, FAAP | Lucas McDuffie, M.D. | Alicia McIntire, RN, CPNP | Julie McKee, RN, M.S., CPNP-AC/PC | Raphael Sun, M.D. | Rachel Wilson, P.A.-C., M.S.

Kenneth Azarow, M.D.

A professional headshot of neurology professor Dr. Kenneth Azarow.

Title: Professor of Surgery

Research Focus: I am interested in how to efficiently educate our next generation of surgeons.

Current projects:

  1. Use of natural language processing from operative reports to determine surgical competency
  2. Genetic analysis to determine risk and outcomes within the diaphragmatic hernia population (DHREAMS trial)
  3. Clinical outcomes in pediatric surgical populations

Select publications:

  1. Leigh Selesner MD, Anthony Gutierrez MD, Cortnie Vaughn MD, Amanda Graveson MD, Ashley Yoo, Asia Wooten, Rachel Wilson PA, Mubeen Jafri MD, Kenneth Azarow MD, Sanjay Krishnaswami, MD, Elizabeth Fialkowski MD. Standardized Perioperative Protocols and Variance in Pediatric Surgery. JAMA Surg. 2025. 160(10):1108-1116. Published Online: August 20, 2025.  https://doi: 10.1001/jamasurg.2025.2927
  2. Ariela Zenilman, Weijia Fan, Rebecca Hernan, Julia Wynn, Alexey Abramov, Christiana Farkouh-Karoleski, Gudrun Aspelund, Usha Krishnan, Julie Khlevner, Ken Azarow, Timothy Crombleholme, Robert Cusick, Dai Chung, Melissa Danko, Douglas Potoka, Foong-Yen Lim, David McCulley, George Mychaliska, David Schindel, Samuel Soffer, Amy Wagner, Brad Warner, Wendy Chung, and Vincent Duron. Being Small for Gestational Age Is Not an Independent Risk Factor for Mortality in Neonates with Congenital Diaphragmatic Hernia: A Multicenter Study. J Perinatol.2022. 42:1183-1188.
  3. Shannon N. Acker MD , Jose Diaz-Miron MD , Romeo C. Ignacio MD , Hari Thangarajah MD, MPH , Katie W. Russell MD , Katrine Lofberg MD , Stephen B. Shew MD , Pamela N Peterson MD, MSPH , Lorraine I. Kelley-Quon MD, MSHS , Aaron R. Jensen MD, MEd, MS , Justin Lee MD , Ben Padilla MDi, Caitlin A. Smith MD , Zachary J. Kastenberg MD, MS , Kenneth S. Azarow MD , Daniel J. Ostlie MD , Kasper S. Wang MD , Thomas H. Inge MD, PhD, Western Pediatric Surgery Research Consortium. Attitudes Affecting Decision-making for Use of Radiologic Enteral Contrast in the Management of Pediatric Adhesive Small Bowel Obstruction: A Survey Study of Pediatric Surgeons. J Surg Res. Nov 2021. 267:536-543.
  4. Potts JR 3rd, Fallat ME, Gaskins J, Azarow KS, Caniano DA. Contemporary General Surgery Resident Learning Experience in Pediatric Surgery. Journal of the American College of Surgeons. J Am Coll Surg. 2021. 33(4):564-574. 12:S1072-7515(21)00511-1. doi: 10.1016/j.jamcollsurg.2021.06.019.
  5. Lorraine I. Kelley-Quon, MD, MSHS, Matthew Kirkpatrick, PhD, Robert Ricca, MD, Robert Baird, MD, Calista Harbaugh, MD, Ashley Brady, Paula Garrett, Hale Wills, MD, Jonathan Argo, MD, Karen Diefenbach, MD, Marion Henry, MD, Juan Sola, MD, Elaa Mahdi, MD, Shawn ST. Peter MD, Cynthia Downard MD, Tracy Shields MD,  Kenneth Azarow MD, Adam Goldin, MD, Eugene Kim, MD. Guidelines for Opioid Prescribing in Children and Adolescents after Surgery: A Systematic Review. 2020. JAMA Surg. JAMA Surg. 2021. 156(1):76-90. doi:10.1001/jamasurg.2020.5045.

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Katherine Ballard, D.N.P., CPNP-AC/PC

Katherine Ballard, DNP, CPNP-AC/PC

Title: Assistant Professor of Surgery

Research Focus: I am particularly interested in research related to pediatric trauma.

Current projects:

  • Western Pediatric Cervical Spine Study

Select publications:

  1. Ballard, K. & Bone, C. (2021). Exploring spatially varying relationships between Lyme disease and land cover with geographically weighted regression. Applied Geography, 127. 

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Benjamin Carr, M.D.

Benjamin Carr, M.D.

Title: Assistant Professor of Surgery

Research Focus: I am interested in surgical critical care for neonates and children, and in thoracic anomalies and malformations such as esophageal atresia, congenital diaphragmatic hernia, congenital lung lesions, chylothorax, and tracheomalacia.

Select publications:

  1. Kohne JG, MacLaren G, Rider E, Carr BD, Mallory P, Gebremariam A, Friedman ML, Barbaro RP. Tracheostomy Practices and Outcomes in Children During Respiratory Extracorporeal Membrane Oxygenation. Pediatr Crit Care Med. 2022 Apr 1;23(4):268-276.
  2. Carr BD, Sampang L, Church JT, Mon RA, Gadepalli SK, Attar MA, Perrone EE. Fetal intervention for congenital chylothorax is associated with improved outcomes in early life. J Surg Res. 2018 Nov;231:361-365. 
  3. Carr BD, Gadepalli SK. Does Surgical Management Alter Outcome in Necrotizing Enterocolitis? Clin Perinatol. 2019 Mar;46(1):89-100. 
  4. Carr BD, Grant CN, Overman RE, Gadepalli SK, Geiger JD. Retroperitoneal exploration with Vicryl mesh and fibrin tissue sealant for refractory chylous ascites. J Pediatr Surg. 2019 Mar;54(3):604-607.

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Elizabeth Fialkowski, M.D.

Dr. Elizabeth Fialkowski

Title: Associate Professor of Surgery

Research Focus: My clinical research focuses include pediatric surgical oncology and quality improvement in pediatric surgical care.

Current projects:

  • Multiple retrospective and prospective studies, both institutional and multi-institutional, regarding outcomes in pediatric general surgery

Select publications:

View my full list of publications.

  1. McKay KG, Beckhorn C, Kontchou NT, Kastenberg ZJ, Roach J, Mullapudi B, Lautz TB, Dasgupta R, Talbot LJ, Aldrink JH, Piché N, Craig BT, Cromeens B, Castle SL, Short J, Petroze RT, Mattei P, Rothstein DH, Fialkowski EA, Rich BS, Brown EG, Seemann NM, Le HD, Ahmed TM, Newman EA, Grant CN, Polites SF, Cameron DB, Kim ES, Austin MT, Coakley BA, Murphy JT, Boehmer C, Malek MM, Tracy E, Lovvorn HN 3rd; Pediatric Surgical Oncology Research Collaborative. Renal sarcomas in children and adolescents: a retrospective, multicenter cohort study. EClinicalMedicine. 2025 Dec 18;91:103713. doi: 10.1016/j.eclinm.2025.103713. PMID: 41509607; PMCID: PMC12775861.
  2. Heller K, Ochoa BV, Brierley SF, Padilla BE; Pediatric Inguinal Hernia Collaborative Group; Alhajjat A, Byrd E, Chao SD, Clinker C, Diaz-Miron J, Dantes G, Eldredge RS, Fialkowski EA, Guner Y, Gurria JP, Haddadin Z, Highet A, Huerta CT, Keane OA, Kelley-Quon LI, Laje P, Le H, Lee J, Lesher A, Lin S, Lym L, Pandya SR, Papastefan S, Parrado RH, Perez EA, Ramazani C, Rehrer W, Russell KW, Selesner L, Shideler BL, Slater BJ, Stellon MA, Stephens C, Sutyak KM, Tsao K, Velazco CS, Weber N, Westbrook N, Wieck MM, Yu P. Surgeon annual volume impacts recurrence rates of pediatric inguinal hernia repairs: A multi-institutional study. J Pediatr Surg. 2025 Dec 29:162890. doi: 10.1016/j.jpedsurg.2025.162890. Epub ahead of print. PMID: 41475507.
  3. Srivatsa S, Aldrink JH, Haque MR, Murphy A, Gehle D, Halepota H, Newman EA, Williams K, Mattei P, Johnston WR, Hwang R, Lautz TB, Ayala SA, Piché N, Lemoine CP, Debertin J, Polites SF, Rothstein DH, Riehle KJ, Nchinda N, Malek MM, Rinehardt HN, Gestrich C, Castle SL, Lopez A, Mayes MS, Myers EK, Roach JP, Craig BT, Lal DR, Schuh J, Cromeens BP, Mannava SV, Austin MT, Mayon LK, Kastenberg ZJ, Wallace M, Alexander A, Stellon MA, Le HD, Joshi DS, Chidiac C, Rhee DS, Cameron D, Stetson A, Rich BS, Glick RD, Fialkowski EA, Fowler K, Fareh R, Brown EG, Doyle K, Abril P, Grant C, Dasgupta R, Boehmer C, Mansfield SA. ASO Visual Abstract: Surgical Management and Outcomes in Pediatric Adrenocortical Carcinoma: A Pediatric Surgical Oncology Research Collaborative Study. Ann Surg Oncol. 2025 Dec 21. doi: 10.1245/s10434-025-18869-3. Epub ahead of print. PMID: 41423574.
  4. Selesner L, Hedges M, Pung R, Vaughn C, Burns A, Aloia M, Henson J, Tobias J, Olyaei A, Nizich S, Swift K, Veshagh A, Andres SF, Fialkowski E, Jordan BK, Scottoline B. Increase in Necrotizing Enterocolitis with Cessation of Bifidobacterium longum Subspecies. infantis Administration in Very Low Birthweight Infants: A Single-Center Retrospective Cohort Study. J Pediatr. 2025 Dec 17:114961. doi: 10.1016/j.jpeds.2025.114961. Epub ahead of print. PMID: 41418978.
  5. Srivatsa S, Aldrink JH, Haque MR, Murphy A, Gehle D, Halepota H, Newman EA, Williams K, Mattei P, Johnston WR, Hwang R, Lautz TB, Ayala SA, Piché N, Lemoine CP, Debertin J, Polites SF, Rothstein DH, Riehle KJ, Nchinda N, Malek MM, Rinehardt HN, Gestrich C, Castle SL, Lopez A, Mayes MS, Myers EK, Roach JP, Craig BT, Lal DR, Schuh J, Cromeens BP, Mannava SV, Austin MT, Mayon LK, Kastenberg ZJ, Wallace M, Alexander A, Stellon MA, Le HD, Joshi DS, Chidiac C, Rhee DS, Cameron D, Stetson A, Rich BS, Glick RD, Fialkowski EA, Fowler K, Fareh R, Brown EG, Doyle K, Abril P, Grant C, Dasgupta R, Boehmer C, Mansfield SA. Surgical Management and Outcomes in Pediatric Adrenocortical Carcinoma: A Pediatric Surgical Oncology Research Collaborative Study. Ann Surg Oncol. 2025 Nov 20. doi: 10.1245/s10434-025-18731-6. Epub ahead of print. PMID: 41266918.

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Mubeen A. Jafri, M.D., FACS, FAAP

A professional headshot of Dr. Mubeen Jafri.

Title: Professor of Surgery

Research Focus: I have an interest in following clinical research areas:

  1. Pediatric Trauma Outcomes focused on injury induced coagulopathy, practice standardization/protocol development, and process improvement.
  2. Regional and National system development of Pediatric emergency management during pandemics and disasters particularly utilizing telemedicine.
  3. Enhanced recovery after gastrointestinal surgery with a clinical concentration on Inflammatory Bowel Disease.

Current projects:

  1. Multi-center Pediatric Traumatic Venous Thromboembolism Research Consortium
  2. Western Regional Alliance for Pediatric Emergency Management (WRAP-EM)
  3. Pediatric Pandemic Network (PPP) Trauma and Burns Hub
  4. Enhancing Recovery in Children Undergoing Surgery (ENRICH-US)
  5. Minimizing Variance in Pediatric Surgery (MViPS)

Select publications:

  1. Selesner L, Gutierrez A, Vaughn C, Graveson A, Yoo A, Wilson R, Jafri M., et al. Standardized perioperative protocols and variance in pediatric surgery. JAMA Surg. 2025 Aug 20:e252927. PMID 40833680
  2. Selesner L, Yorkgitis B, Martin M, Ng G, Mukherjee K, Ignacio R, Freeman J, Wong L, Durbin S, Crandall M, Longshore S, Gerall C, Flynn-O’Brien K, Jafri M.  Emergency Department Thoracotomy in Children:  A Pediatric Trauma Society (PTS), Western Trauma Association (WTA), and Eastern Association for the Surgery of Trauma (EAST) Systematic Review and Practice Management Guideline.  J Trauma Acute Care Surg. 2023 Sep 1;95(3):432-441. PMID 37608453
  3. Tobias J, Cunningham A, Krakauer K, Nacharaju D, Moss L, Galindo C, Roberts M, Hamilton NA, Olsen K, Emmons M, Quackenbush J, Schreiber MA, Burns BS, Sheridan D, Hoffman B, Gallardo A, Jafri MA. Protect Our Kids: a novel program bringing hemorrhage control to schools. Inj Epidemiol. 2021 Sep13;8(Suppl 1):31. PMID: 34517905
  4. Labuz DF, Cunningham A, Tobias J, Dixon A, Dewey E, Marenco CW, Escobar MA Jr, HazeltineMD, Cleary MA, Kotagal M, Falcone RA Jr, Fallon SC, Naik-Mathuria B, Mac Arthur T, Klinkner DB, Shah A, Chernoguz A, Orioles A, Zagel A, Gosain A, Knaus M, Hamilton NA, Jafri MA. Venous Thromboembolic Risk Stratification in Pediatric Trauma:  A Pediatric Trauma Society Research Committee Multicenter Analysis. J Trauma Acute Car Surg. 2021 Oct 1;91(4):605-611. PMID 34039921
  5. Russell RT, Esparaz JR, Beckwith MA, Abraham PJ, Bembea MM, Borgman MA, Burd RS, Gaines BA, Jafri M, et al. Pediatric Traumatic Hemorrhagic Shock Consensus Conference Recommendations. J Trauma Acute Care Surg. 2023 Jan 1;94(1S Suppl1):S2-S10.  PMID 36245074

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Lucas McDuffie, M.D.

Lucas McDuffie, M.D.

Title: Assistant Professor of Surgery

Research Focus: I have an interest in clinical research related to outcomes in the treatment of pediatric surgical diseases, with a specific focus on trauma systems both domestically and internationally, pediatric surgical oncology, and chest wall/pectus reconstruction.

Current projects:

  • Multiple single institutional studies and multiple consortium studies

Select publications:

  1. Vaughn CR, Fialkowski E, McDuffie L. Pediatric Lymph Node Biopsy: Indications, Techniques, and Complications. Eur J Haematol. 2025 Sep 6. doi: 10.1111/ejh.70028. Epub ahead of print. PMID: 40913442.
  2. Eldredge RS, Padilla BE, Kahan AM, Nicassio L, Chao SD, Schwab M, Diaz-Miron J, Ibarra A, Pandya S, Ryan M, Gillory L, Lee J, Ignacio RC, Keller BA, Scaife JH, Clinker CE, McDuffie LA, Byrd E, Rothstein D, Kelley-Quon LI, Kim S, Ostlie DJ, Russell KW. Effect of activity restrictions on pectus bar displacement following minimally invasive repair of pectus excavatum - A Western Pediatric Surgery Research Consortium. J Pediatr Surg. 2026 Jan;61(1):162520. doi: 10.1016/j.jpedsurg.2025.162520. Epub 2025 Aug 8. PMID: 40784579.
  3. Boggs K, Wortham A, Gregoski MJ, Pruitt CM, McDuffie LA. Pediatric Golf Cart Injuries and Morbidity: A Single-Center Trauma Experience. Pediatr Emerg Care. 2025 May 1;41(5):383-387. doi: 10.1097/PEC.0000000000003350. 2025 Feb 6. PMID: 39912459.
  4. Selesner L, Ballard K, Azarow KS, McDuffie LA. Office-Based Procedures in Children. Surg Clin North Am. 2025 Aug;105(4):821-842. doi: 10.1016/j.suc.2025.02.001. Epub 2025 Mar 29. PMID: 40581474.
  5. Teke M, Rich BS, Walther A, Schwartz D, McDuffie LA, Butera G, Roach JP, Rothstein DH, Lal DR, Riehle K, Espinoza A, Cost N, Tracy E, Rodeberg D, Lautz T, Aldrink JH, Brown EG. A Comparison of Commonly Utilized Diagnostic Biopsy Techniques for Pediatric Patients With Cancer: A Systematic Review by the APSA Cancer Committee. J Pediatr Surg. 2025 Feb;60(2):161893. doi: 10.1016/j.jpedsurg.2024.161893. Epub 2024 Sep 2. PMID: 39317569.

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Alicia McIntire, RN, CPNP

Alicia McIntire, RN, CPNP

Title: Instructor of Surgery

Research Focus: I am interested in pediatric surgical research to better understand childhood disease processes in an attempt to improve care and outcomes for pediatric surgical patients.

Current projects:

  • Diaphragmatic Hernia Research & Exploration, Advancing Molecular Sciences (DHREAMS)
  • Congenital Diaphragmatic Hernia Study Group (CDHSG) Registry
  • Prospective Longitudinal Trial Evaluating Operative vs Non-Operative Management of Pancreatic Injuries in the Pediatric Population
  • Perianal Abscess Observational Database -Various pediatric trauma studies

Select publications:

  1. Downie K, McIntire A, Tobias J, Krishnaswami S, Jafri M. Application of a Thoracic CT Decision Rule in the Evaluation of Injured Children: A Quality Improvement Initiative. J Trauma Nurs. 2023 Jan-Feb 01;30(1):48-54. 
  2. Hanson HR, Formica M, Laraque-Arena D, Zonfrillo MR, Desai P, O'Neil JO, Unni P, Johnson EL, Cobb P, Agarwal M, Beckworth K, Schroter S, Strotmeyer S, Donnelly KA, Middelberg LK, Morse AM, Dodington J, Latuska RF, Anderson B, Lawson KA, Valente M, Levas MN, Kiragu AW, Monroe K, Ruest SM, Lee LK, Charyk Stewart T, Attridge MM, Haasz M, Jafri M, McIntire A, Rogers SC, Uspal NG, Blanchard A, Hazeltine MD, Riech T, Jennissen C, Model L, Fu Q, Clukies LD, Juang D, Ruda MT, Prince JM, Chao S, Yorkgitis BK, Pomerantz WJ. A multicenter evaluation of pediatric emergency department injury visits during the COVID-19 pandemic. Inj Epidemiol. 2023 Dec 13;10(1):66. 

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Julie McKee, RN, M.S., CPNP-AC/PC

Julie McKee

Title: Instructor of Surgery

Research Focus: I am focused on quality and process improvement in the surgical care of pediatric patients.

Current projects:

  • Hospital Unit Variation in Pediatric Postoperative Opioid Administration
  • Evaluating current opioid use in pediatric patients following laparoscopic gastrostomy surgery in NICU and pediatric ward

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Raphael Sun, M.D.

Raphael Sun, M.D.

Title: Assistant Professor of Surgery; Fetal Surgery Program Co-Director

Research Focus: I am interested in fetal anomalies related to fetal and pediatric surgery that can be intervened on and focused on improving clinical outcomes both prenatally and postnatally.

Current projects:

  • Impact of Structural Determinants of Health on Morbidity and Mortality of Infants with Surgically Intervenable Congenital Anomalies
  • Health disparities in prenatal care and its effect on postnatal neonatal outcomes
  • Congenital lung lesion prenatal ultrasound, diagnosis and management
  • Congenital diaphragmatic hernia 

Select publications:

  1. Creden SP, Portuondo J, Cheng LS, Halaweish I, Keswani SG, King AL, Lee TC, Sun RC. Approach and Technique for Cesarean Section to Immediate Resection for High-Risk Sacrococcygeal Teratomas. J Surg Res. 2023 Dec;292:38-43.
  2. Seaman RD, Salmanian B, Shamshirsaz AA, Espinoza J, Sanz-Cortes M, Donepudi R, Johnson R, Krispin E, Sun R, Belfort MA, Nassr AA. Pregnancy outcomes following early fetoscopic laser photocoagulation for twin-to-twin transfusion syndrome at 16 weeks' gestation. Am J Obstet Gynecol MFM. 2023 Jan;5(1):100771. 
  3. Sun RC, Hessami K, Krispin E, Pammi M, Mostafaei S, Joyeux L, Deprest J, Keswani S, Lee TC, King A, Belfort MA, Shamshirsaz AA. Prenatal ultrasonographic markers for prediction of complex gastroschisis and adverse perinatal outcomes: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed. 2022 Jul;107(4):371-379.
  4. Sun RC, Mehl SC, Anbarasu CR, Portuondo JI, Espinoza AF, Whitlock R, Mazziotti MV. Intercostal cryoablation during Nuss procedure: A large volume single surgeon's experience and outcomes. J Pediatr Surg. 2021 Dec;56(12):2229-2234.
  5. Espinoza J, Shamshirsaz AA, Sanz Cortes M, Pammi M, Nassr AA, Donepudi R, Whitehead WE, Castillo J, Johnson R, Meshinchi N, Sun R, Krispin E, Corroenne R, Lee TC, Keswani SG, King A, Belfort MA. Two-port, exteriorized uterus, fetoscopic meningomyelocele closure has fewer adverse neonatal outcomes than open hysterotomy closure. Am J Obstet Gynecol. 2021 Sep;225(3):327.e1-327.e9. 
  6. Mehl SC, Short WD, Kinley A, Lee TC, Sun RC, Belfort MA, Shamshirsaz AA, Espinoza J, Donepudi R, Sanz-Cortes M, Nassr AA, Mehollin-Ray AR, Keswani SG, King A. Delivery planning for congenital lung malformations: A CVR based perinatal care algorithm. J Pediatr Surg. 2022 May;57(5):833-839.
  7. Sun RC, Cheng LS, Shah RH, Lohmann P, Cortes-Santiago N, Ketwaroo PD, Keswani SG, King A, Lee TC. Case Report: The Medical and Surgical Management of an Infant With Extreme Prematurity and Fetus-In-Fetu. Front Surg. 2022 Mar 4;9:856837.
  8. Mehl SC, Short WD, Flanagan MM, Keswani SG, Lee TC, Sun RC, Vogel AM, Austin PF, King A. Correlation of continence with long-term patient centered outcomes in children with sacrococcygeal teratoma. J Pediatr Surg. 2022 May;57(5):871-876.

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Rachel Wilson, P.A.-C., M.S.

Rachel Wilson, PA-C

Title: Assistant Professor of Surgery

Research Focus: I aim to contribute to ongoing Pediatric Surgery research in order to gain a better understanding, improved or standardized care across various surgical and disease processes.

Current projects:

  • Minimizing variance in pediatric surgery - various studies to standardize different aspects of care
  • VTE prophylaxis - looking at utility of screening duplex US in pediatric surgery patients
  • Various multi-institutional studies

Select publications:

  1. Wilson RE, Rao PK, Cunningham AJ, Dewey EN, Krishnaswami S, Hamilton NA. A Natural History of Gastrojejunostomy Tubes in Children. J Surg Res. 2020 Jan;245:461-466. 
  2. Sunstrom R, Hamilton N, Fialkowski E, Lofberg K, McKee J, Sims T, Krishnaswami S, Azarow K. Minimizing variance in pediatric gastrostomy: does standardized perioperative feeding plan decrease cost and improve outcomes? Am J Surg. 2016 May;211(5):948-53.
  3. Tobias J, Saunders L, Wilson R, Vu K, Spurrier R, Fialkowski E. A novel gastrografin challenge protocol in pediatric adhesive small bowel obstruction. North Pacific Surgical Association, virtual conference, Sept 2020.
  4. Tobias J, Labuz DF, Cunningham A, Dixon A, Selesner L, Moss L, Dewey E, Haley KM, Burns E, Schreiber M, Wilson R, Hamilton NA, Jafri MA. Venous thromboembolic screening in pediatric trauma: A prospective cohort study of risk-stratified ultrasonography. J Trauma Acute Care Surg. 2023 Jan 1;94(1):107-112.

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