Core Outcomes in Children undergoing Anesthesia and Surgery: A multi-center stakeholder engagement study
• Researchers studying children undergoing anesthesia and surgery currently lack guidance about what outcomes are important to measure. As a result, a wide range of different outcomes are measured in their research, outcomes that have unclear relevance to children, parents, and their healthcare team.
• In this project we will be directly engaging members of these stakeholder groups to identify those outcomes that these stakeholders consider most important after surgery in children.
• The overall study aim is to ask key stakeholder groups to identify outcomes of greatest importance for pediatric patients undergoing anesthesia and surgery. Specifically, we will undertake surveys and semistructured interviews to gather views from pediatric surgical patients, their parents/guardians, and perioperative healthcare professionals about what outcomes are important.

Intra-operative Cell Salvage for Pediatric Bone Cancer Surgery
• Osteosarcoma and Ewing sarcoma are bone cancers that typically occur in children and are usually treated with a combination of surgery, chemotherapy, and radiotherapy. The possibility of major blood loss during the operation is high and transfusion of donated blood, with all the attendant risks, is often required.
• Intra-operative cell salvage refers to the collection, processing, and re-transfusion of blood lost during surgery. This well-established technique minimizes the need for transfusion of donated blood, but its adoption for cancer surgery has been limited by the theoretical risk of reintroducing tumor cells into the patient’s bloodstream. While recent evidence that a special filter effectively removes tumor cells from salvaged blood has led to increased use of cell salvage during cancer surgery in adults, its use in children remains uncommon.
• In a new collaboration between The Department of Anesthesia and The Department of Pathology and Laboratory Medicine, we propose a two-part study to investigate the safety and efficacy of cell salvage during bone cancer surgery in children. Phase I is laboratory based and will use flow cytometry to determine the lower limit of detection of tumor cells in blood. In Phase II we will use patient blood collected through cell salvage, with and without a filter, to determine the number of tumor cells present.