Publications by authors named "Justin T Huntington"

16 Publications

  • Page 1 of 1

Improving care through standardized treatment of spontaneous pneumothorax.

J Pediatr Surg 2021 Jan 6;56(1):55-60. Epub 2020 Oct 6.

Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH. Electronic address:

Purpose: The objective of this quality improvement (QI) initiative was to implement a standardized clinical treatment protocol for patients presenting with primary spontaneous pneumothorax (PSP) in order to decrease hospital length of stay (LOS), diagnostic radiation exposure, and related cost.

Methods: Baseline data from patients admitted with PSP from January 1, 2016 to July 31, 2018 were compared to data from patients managed using a newly developed evidence-based treatment pathway from August 1, 2018 to December 31, 2019. Standard QI methodology was used to track results.

Results: Fifty-six episodes of PSP were observed during the baseline period and 40 episodes of PSP following initiation of the PSP protocol. The average LOS decreased from 4.5 days to 2.9 days. Patients underwent an average of 8.8 X-rays per admission preintervention versus 5.9 postintervention. The rate of CT scans decreased from 45% to 15% (p = 0.002). There was no significant difference in the rates of 30-day recurrence between the preintervention (13%) and postintervention (10%) groups (p = 0.7). Average admission costs per patient decreased by $1322 after adoption of the pathway.

Conclusions: Adoption of a standardized treatment protocol for PSP led to a reduction in LOS, diagnostic imaging utilization, and cost without increasing clinical recurrence.

Type Of Study: Quality improvement.

Level Of Evidence: Level III.
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http://dx.doi.org/10.1016/j.jpedsurg.2020.09.048DOI Listing
January 2021

The pediatric surgery match by the numbers: Defining the successful application.

J Pediatr Surg 2020 Jun 28;55(6):1053-1057. Epub 2020 Feb 28.

Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH; Center for Surgical Outcomes Research, Nationwide Children's Hospital Research Institute, Nationwide Children's Hospital, Columbus, OH.

Background: Pediatric surgery remains the most competitive general surgery subspecialty. The authors suspected significant inflation in academic metrics since the last published paper. This study aimed to identify factors associated with applicant success in the match.

Methods: After IRB approval, all applications to a single accredited pediatric surgery fellowship program were reviewed for match years 2014-2018. Matched and unmatched applicants were compared in an unadjusted and adjusted analysis.

Results: This training program received 414 of 425 total applications (97%). Match results were available for 388 (94%). Matched applicants were more likely to train in programs with pediatric surgery fellowships (64% vs. 28%) and to have dedicated research time (55% vs. 21%; all p < 0.01). Matched applicants had more total publications (median: 12 vs. 7, p < 0.01) and higher ABSITE scores (median: 64th vs. 59th percentile, p < 0.01). Training in multiple programs negatively impacted the chance to match (p < 0.01). The median number of publications per applicant increased over the study time period from 7 to 11 (p < 0.01).

Conclusions: The likelihood of matching into a pediatric surgery fellowship was related to the type of residency attended, dedicated research time, ABSITE scores, and number of publications. Overall, the total number of publications reported by all applicants increased.

Type Of Study: Retrospective Comparative Study.

Level Of Evidence: Level III.
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http://dx.doi.org/10.1016/j.jpedsurg.2020.02.052DOI Listing
June 2020

Complications after proctocolectomy and ileal pouch-anal anastomosis in pediatric patients: A systematic review.

J Pediatr Surg 2019 Jul 19;54(7):1331-1339. Epub 2018 Sep 19.

Division of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, USA 43205; Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Columbus, OH, USA 43210. Electronic address:

Background/purpose: Colectomy with ileal pouch-anal anastomosis (IPAA) is the standard of care for patients with familial adenomatous polyposis (FAP) and refractory ulcerative colitis (UC). The rates of postoperative complications are not well established in children. The objective of this systematic review is to establish benchmark data for morbidity after pediatric IPAA.

Methods: PubMed, Embase, and The Cochrane Library were searched for studies of colectomy with IPAA in patients ≤21 years old. UC studies were limited to the anti-tumor necrosis factor-α agents era (1998-present). All postoperative complications were extracted.

Results: Thirteen studies met the inclusion criteria (763 patients). Compared to patients with FAP, UC patients had a higher prevalence of pouch loss (10.6% vs. 1.5%). Other major complications such as anastomotic leak, abscess, and fistula were uncommon (mean prevalence 4.9%, 4.2%, and 5.0%, respectively, for patients with UC; 8.7%, 4.2%, and 4.3% for FAP). The most frequent complication was pouchitis (36.4% of UC patients).

Conclusions: Devastating complications from colectomy and IPAA are rare, but patients with UC have poorer outcomes than those with FAP. Much of the morbidity may therefore stem from patient or disease factors. Multicenter, prospective studies are needed to identify modifiable risks in patients with UC undergoing IPAA.

Level Of Evidence: Prognostic, level II.
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http://dx.doi.org/10.1016/j.jpedsurg.2018.08.047DOI Listing
July 2019

Adenocarcinoma Arising From an End Ileostomy in a Patient With Familial Adenomatous Polyposis.

Clin Gastroenterol Hepatol 2017 04 24;15(4):A27-A28. Epub 2016 Nov 24.

Division of General Surgery, Colorectal Surgery Division, The Ohio State University Wexner Medical Center, Columbus, Ohio.

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http://dx.doi.org/10.1016/j.cgh.2016.11.022DOI Listing
April 2017

Comparing laparoscopic versus open Ladd's procedure in pediatric patients.

J Pediatr Surg 2017 Jul 30;52(7):1128-1131. Epub 2016 Oct 30.

Division of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH; Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH. Electronic address:

Background/purpose: The objective of this study was to perform a comparative analysis of laparoscopic versus open Ladd's procedure on 30-day postoperative outcomes.

Methods: All elective Ladd's procedures performed on patients with intestinal malrotation in the 2013-2014 National Surgical Quality Improvement Program Pediatric were identified. A propensity score-matched analysis was used to account for baseline differences between groups, and generalized estimating equations (GEEs) were used to compare 30-day outcomes between open versus laparoscopic groups.

Results: Fifty-eight (18.6%) patients underwent laparoscopic Ladd's while 253 (81.4%) underwent an open technique. After propensity score matching, 53 laparoscopic cases (38.1%) and 86 open cases (61.9%) were identified and compared for outcomes. Total length of stay was shorter for the laparoscopic group compared to the open group (6 vs. 4days, p<0.001). Postoperative length of stay was shorter for the laparoscopic group as well (5 vs. 4days, p<0.001). Postoperative complications occurred in 5 laparoscopic cases (9.4%) and in 18 open cases (20.9%), but did not meet statistical significance (p=0.08). One laparoscopic patient (1.9%) and 8 open patients (9.3%) required hospitalization beyond 30days, but this also did not meet significance (p=0.08).

Conclusions: In a matched analysis, laparoscopic Ladd's led to shorter hospital stays than open Ladd's in the initial 30-day postoperative period. Short-term benefits of laparoscopic Ladd's lend support for using additional resources to perform multi-institutional studies to compare differences in long-term outcomes between laparoscopic and open Ladd's.

Type Of Study: Therapeutic LEVEL OF EVIDENCE: III.
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http://dx.doi.org/10.1016/j.jpedsurg.2016.10.046DOI Listing
July 2017

A case of a pseudo colonic mass causing gastrointestinal bleeding in a patient with a left ventricular assist device.

Int J Crit Illn Inj Sci 2016 Jul-Sep;6(3):153-154

Division of General Surgery, The Ohio State University, Columbus, OH 43210, USA.

There are many complications associated with the left ventricular assist devices (LVADs), including gastrointestinal bleeding (GIB). We present a case of a pseudo colonic mass visualized on colonoscopy during workup for GIB in an LVAD patient necessitating a right colectomy with final pathology negative for malignancy. A review of the literature in regards to the pathology, diagnosis, and treatment of this interesting condition is included.
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http://dx.doi.org/10.4103/2229-5151.190646DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5051059PMC
October 2016

E2f8 mediates tumor suppression in postnatal liver development.

J Clin Invest 2016 08 25;126(8):2955-69. Epub 2016 Jul 25.

E2F-mediated transcriptional repression of cell cycle-dependent gene expression is critical for the control of cellular proliferation, survival, and development. E2F signaling also interacts with transcriptional programs that are downstream of genetic predictors for cancer development, including hepatocellular carcinoma (HCC). Here, we evaluated the function of the atypical repressor genes E2f7 and E2f8 in adult liver physiology. Using several loss-of-function alleles in mice, we determined that combined deletion of E2f7 and E2f8 in hepatocytes leads to HCC. Temporal-specific ablation strategies revealed that E2f8's tumor suppressor role is critical during the first 2 weeks of life, which correspond to a highly proliferative stage of postnatal liver development. Disruption of E2F8's DNA binding activity phenocopied the effects of an E2f8 null allele and led to HCC. Finally, a profile of chromatin occupancy and gene expression in young and tumor-bearing mice identified a set of shared targets for E2F7 and E2F8 whose increased expression during early postnatal liver development is associated with HCC progression in mice. Increased expression of E2F8-specific target genes was also observed in human liver biopsies from HCC patients compared to healthy patients. In summary, these studies suggest that E2F8-mediated transcriptional repression is a critical tumor suppressor mechanism during postnatal liver development.
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http://dx.doi.org/10.1172/JCI85506DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4966321PMC
August 2016

Single-incision laparoscopic surgery (SILS) for children with Crohn's disease.

Pediatr Surg Int 2016 May 13;32(5):459-64. Epub 2016 Feb 13.

Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.

Purpose: Single-incision laparoscopic surgery (SILS) has been described in adults with Crohn's disease, but its use in pediatric Crohn's patients has been limited. The purpose of this study was to review our experience with SILS in pediatric patients with Crohn's disease.

Methods: A retrospective review was performed for patients diagnosed with Crohn's disease who underwent small bowel resection or ileocecectomy at a freestanding children's hospital from 2006 to 2014. Data collected included demographic data, interval from diagnosis to surgery, operative time, length of stay, and postoperative outcomes.

Results: Analysis identified 19 patients who underwent open surgery (OS) and 41 patients who underwent SILS. One patient (2.4 %) within the SILS group required conversion to OS. Demographic characteristics were similar between the 2 cohorts. The most common indication for surgery was stricture/obstruction (SILS 70.7 % vs. OS 68.4 %, p = 0.86), and ileocecectomy was the most common primary procedure performed (SILS 90.2 % vs. OS 100 % OS). Operative times were longer for SILS (135 ± 50 vs. 105 ± 37 min, p = 0.02). However, when the last 20 SILS cases were compared to all OS cases, the difference was no longer statistically significant (SILS 123.3 ± 34.2 vs. OS 105 ± 36.5, p = 0.12). No difference was noted in postoperative length of stay (SILS 6.5 ± 2.2 days vs. OS 7.4 ± 2.2 days, p = 0.16) or overall complication rate (SILS 24.4 % vs. OS 26.3 %, p = 0.16).

Conclusion: SILS ileocecectomy is feasible in pediatric patients with Crohn's disease, achieving outcomes similar to OS. As experience increased, operative times also became comparable.
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http://dx.doi.org/10.1007/s00383-016-3875-4DOI Listing
May 2016

The Spectrum of E2F in Liver Disease--Mediated Regulation in Biology and Cancer.

J Cell Physiol 2016 Jul 2;231(7):1438-49. Epub 2016 Feb 2.

Department of Molecular Virology, Immunology and Medical Genetics, College of Medicine, Columbus, Ohio.

Uncoordinated cell growth is one of the fundamental concepts in carcinogenesis and occurs secondary to dysregulation of the cell cycle. The E2Fs are a large family of transcription factors and are key regulators of the cell cycle. The activation of E2Fs is intimately regulated by retinoblastoma 1 (RB1). The RB pathway has been implicated in almost every human malignancy. Recently there have been exciting developments in the E2F field using animal models to better understand the role of E2Fs in vivo. Genetic mouse models have proven essential in implicating E2Fs in hepatocellular carcinoma (HCC) and liver disease. In this review, the general structure and function of E2Fs as well as the role for E2Fs in the development of HCC and liver disease is evaluated. Specifically, what is known about E2Fs in human disease is explored in depth, and future directions are discussed.
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http://dx.doi.org/10.1002/jcp.25242DOI Listing
July 2016

Minimally Invasive Ileal Pouch-Anal Anastomosis with Rectal Eversion Allows for Equivalent Outcomes in Continence in Pediatric Patients.

J Laparoendosc Adv Surg Tech A 2016 Mar 13;26(3):222-5. Epub 2015 Nov 13.

1 Department of Pediatric Surgery, Nationwide Children's Hospital , Columbus, Ohio.

Background: Different techniques for ileal pouch-anal anastomosis (IPAA) following total proctocolectomy (TPC) have been described in patients with ulcerative colitis (UC), including rectal eversion (RE). RE allows for precise identification of the dentate line, but concerns have been raised regarding continence rates. No studies have specifically evaluated RE in the pediatric population. The purpose of this study was to evaluate the outcomes and continence rates for pediatric patients undergoing minimally invasive surgery (MIS) TPC and IPAA with RE for UC.

Materials And Methods: All patients who underwent TPC and IPAA were reviewed at our institution. Data collected included demographics, proctocolectomy technique (open without RE versus MIS with RE), operative time, postoperative data, and continence outcomes following ileostomy closure.

Results: Thirty-three patients were identified who underwent TPC and IPAA between July 2006 and October 2014. Thirty of these patients underwent ileostomy takedown and were evaluated for continence. Of these, 17 (56.7%) patients had a laparoscopic procedure, 5 (16.7%) had a robotic-assisted procedure, and 8 (26.7%) had an open procedure. There were no statistically significant differences in regard to demographics, operative time, or length of stay when comparing the two groups. There were no differences in the two groups as measured at 1, 6, and 12 months in terms of number of daily stools (P = .93, .09, and .87, respectively), nighttime stooling (P = .29, .10, and .25, respectively), soiling (P = .43, .36, and .52, respectively), or stool-altering medication usage (P = .26, 1.00, and .37, respectively).

Conclusions: The RE technique can be used safely and effectively during MIS TPC and IPAA in children without altering continence rates.
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http://dx.doi.org/10.1089/lap.2015.0429DOI Listing
March 2016

A case of a strangulated umbilical hernia causing gangrenous appendicitis.

Int J Colorectal Dis 2016 May 6;31(5):1075-1076. Epub 2015 Oct 6.

Division of General Surgery, The Ohio State University, 395 W 12th Avenue, Columbus, OH, 43210, USA.

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http://dx.doi.org/10.1007/s00384-015-2412-6DOI Listing
May 2016

Angiosarcoma: A rare malignancy with protean clinical presentations.

J Surg Oncol 2015 Jun 28;111(8):941-50. Epub 2015 May 28.

Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center - James Cancer Hospital and Solove Research Institute, Columbus, Ohio.

Angiosarcoma is a rare form of soft tissue sarcoma. Primary small intestinal angiosarcomas are especially uncommon. The clinical presentations of small intestinal angiosarcomas vary but gastrointestinal (GI) bleeding is a frequent finding. We present a case of persistent GI bleeding of unknown etiology culminating in operative exploration demonstrating a primary small intestinal angiosarcoma. A discussion of the diagnosis, pathology, and management of angiosarcoma with a review of the current literature is provided including molecular genetics, difficult cases, and current treatment options.
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http://dx.doi.org/10.1002/jso.23918DOI Listing
June 2015

A case of pediatric cecal diverticulitis mimicking acute appendicitis.

Int J Colorectal Dis 2016 Jan 3;31(1):147-8. Epub 2015 Mar 3.

Division of Pediatric Surgery, Nationwide Children's Hospital, Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA.

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http://dx.doi.org/10.1007/s00384-015-2171-4DOI Listing
January 2016

Endoscopic mucosal resection for staging and treatment of early esophageal carcinoma: a single institution experience.

Surg Endosc 2015 Aug 4;29(8):2121-5. Epub 2014 Dec 4.

Division of General and Gastrointestinal Surgery, The Ohio State University, Columbus, OH, 43210, USA,

Background: Endoscopic mucosal resection (EMR) has emerged for evaluation and treatment of esophageal nodules. We report our initial experience with EMR for T staging and management of early esophageal cancer.

Methods: We reviewed patients undergoing EMR for esophageal adenocarcinoma between 2008 and 2013. The primary outcome measure was needed for esophagectomy. Secondary outcomes included complete eradication of adenocarcinoma, recurrence or persistence of cancer, nodal status for those undergoing esophagectomy, and complications of endoscopic treatment.

Results: During the study period, 24 patients underwent EMR demonstrating carcinoma, and a grossly margin negative endoscopic resection was achieved in all cases. Ten patients (42 %) had evidence of submucosal invasion and were referred for esophagectomy. Patients with margin negative EMR (n = 10, 42 %) or positive radial margins (n = 4, 16 %) underwent endoscopic surveillance and treatment with radiofrequency ablation or repeat EMR as needed. Thirteen patients (93 %) with intramucosal cancer (IMC) have been successfully managed with ongoing endoscopic surveillance and treatment with a median follow-up of 15.5 months. One patient underwent esophagectomy due to recurrent IMC in the setting of long-segment multifocal high-grade dysplasia. There were no esophageal perforations, one patient developed a self-limited gastrointestinal hemorrhage following EMR, and one had an esophageal stricture following endoscopic management.

Conclusions: IMC can be successfully managed endoscopically and thus esophagectomy is avoided in a significant proportion of patients. Endoscopic management may be utilized in the setting of complete resection or radial margin involvement without evidence of submucosal invasion. Close endoscopic follow-up is of paramount importance even in those with negative margins, because recurrent disease may occur following EMR in these patients.
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http://dx.doi.org/10.1007/s00464-014-3962-3DOI Listing
August 2015

Minimizing blood loss during hepatectomy: a literature review.

J Surg Oncol 2014 Feb 4;109(2):81-8. Epub 2013 Oct 4.

Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.

There are numerous techniques surgeons employ to reduce blood loss during partial hepatectomy. In this literature review, prospective studies from the last 20 years are examined to determine the techniques that are best supported by the literature. Some of the techniques include vascular control, multiple parenchymal transection techniques, various hemostatic agents, low central venous pressure, and hemodilution. The strategies supported most convincingly by the literature include low CVP and total hepatic inflow occlusion.
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http://dx.doi.org/10.1002/jso.23455DOI Listing
February 2014

The Social Security Death Index (SSDI) most accurately reflects true survival for older oncology patients.

Am J Cancer Res 2013 1;3(5):518-22. Epub 2013 Nov 1.

Division of Surgical Oncology, The Ohio State University Wexner Medical Center Columbus, OH, USA.

Introduction: The ability to ascertain survival information is important for retrospective and prospective studies. Two databases that can be used are the Social Security Death Index (SSDI) and the National Death Index (NDI). Although the NDI is more complete, there are advantages to the SSDI such as ease of use and cost. The intent of this study was to determine accuracy of the SSDI.

Methods: Publically available data on all known deceased individuals in the state of Ohio in 2003 were obtained from the State of Ohio Department of Health. A random sample of 63,557 of these were compared to the SSDI to identify risk factor for inclusion/exclusion.

Results: Overall, 94.7% of all death records were confirmed by the SSDI. Age at death, gender, race, ethnicity, and cause of death were all found to significantly affect the likelihood of inclusion. Specifically, people aged 18-24 were included only 79.8% of the time compared to 96.2% for those over the age of 65. Also, malignancy as cause of death resulted in a 95.3% inclusion while trauma as a cause of death led to 86.5% inclusion. While Caucasians had an inclusion of 95.6%, African Americans were included only 87.8% of the time. Hispanics and women also had lower inclusion rates.

Discussion: The SSDI is a strong tool for following up on participants lost to follow up in certain populations but is weaker in others. The SSDI would be particularly useful in a population that is largely older, Caucasian, or has malignant disease.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3816971PMC
November 2013