Nationally Ranked in out 10 of 10 Pediatric Specialties

Surgery Annual Report 2019 Table of contents Welcome to at Riley Children’s Health Welcome to Surgery at Riley Children’s Health ...... 1 As pediatric surgeons and dedicated perioperative surgical teams, one of our most important jobs is to offer hope to children About Riley Children’s Health ...... 2 and families—to restore health, normalcy and the promise of a bright future. Our latest Riley Children’s Health Surgery Annual Report provides an overview of our surgical specialties*, highlighting the expertise, innovation and commitment that Riley Surgery at a glance ...... 5 enable us to reach these goals. Riley Surgical Research Day ...... 5 Working in collaboration with nurses, anesthesiologists, child life specialists and other multidisciplinary team members, Maternity Tower at Riley Hospital for Children at IU Health ...... 6 surgeons at Riley performed more than 19,000 operating room Surgical specialties procedures in 2019. Everyone involved with Riley Surgery—from ...... 8 team members in environmental services and sterile processing Riley Surgery expands virtual care ...... 10 to our colleagues in the operating room—contributes to providing children and families with exceptional patient experiences and the Many of our surgical specialties are using Interventional and Electrophysiology ...... 12 Nationally out Pediatric best possible outcomes. virtual visits to increase statewide access Interventional ...... 14 Ranked in 10 of 10 Specialties to Riley’s skilled surgical teams. During the Maternal Fetal ...... 16 Our partnership with Indiana University School of Medicine and COVID-19 pandemic, virtual care outreach ...... 18 Cancer our long-standing commitment to research and scholarly activity —via a secure, user-friendly app—has ...... 20 continue to set Riley at IU Health apart from others locally, expanded to include not only critical follow- ...... 22 Cardiology & 5th regionally and nationally. As our surgical program and capabilities IN THE up visits, but also initial assessments. Heart Surgery NATION continue to grow, we’re excited about the future of Riley Surgery, Otolaryngology – Head & Neck Surgery ...... 24 Using close observation and patient family marked by progress in the areas of fetal intervention, precision ...... 26 Diabetes & consultation, Riley neurosurgeons are now surgery, artificial intelligence and machine learning, and further ...... 28 performing thorough pediatric neurological refinement and use of minimally invasive surgical techniques. Transplant Surgery ...... 30 exams virtually. Riley Pediatric Surgery can ...... 32 & GI Surgery On behalf of our entire surgical team, I hope you enjoy learning facilitate nearly any type of preoperative or more about our dedicated team members and the 13 specialties postoperative appointment with a virtual visit. Anesthesia ...... 34 TOP 15 that comprise Riley Surgery. With a commitment and passion for Trauma Services ...... 36 children’s health that’s unmatched, our team strives every day to & Kidney Diseases TOP Riley Surgery Team Member Directory ...... 38 15 make a difference in the lives of children and families by restoring & Neurosurgery TOP health and working to ensure improved quality of life. Refer a patient ...... 41 25 Orthopedics

Pulmonology & Lung Surgery Frederick J. Rescorla, MD 2nd Urology IN THE Surgeon-in-Chief NATION

On the cover Inspiring patients, Adriana Carrera, age 5, flashes a smile while coloring in one of world-class care: the play rooms at Riley. A sudden onset of pain led to her visit. The pain began during the day stories of Riley kids and continued into the night so Surgeons and surgical teams her parents took her to the Riley at Riley Children’s Health treat Emergency department. Riley thousands of children each year. discovered an issue with Adriana’s appendix, and Read some of their stories on within a few hours, she was in pages 3, 4 and 40. * The medical specialties of Riley Children’s Health are highlighted in a separate the operating room. After four annual report. To view this report, visit days recovering from surgery, rileychildrens.org/medicalannualreport; Adriana returned home. print copies may also be requested from [email protected].

Riley Children’s Health Surgery Annual Report 2019 | 1 About Riley Children’s Health

Riley Children’s Health, Indiana’s largest and most Riley Children’s Health Statewide Reach skilled pediatric system, provides care in more Story of a Riley kid: South Bend than 50 locations in communities across Indiana. Crown Point Connor Guthrie, age 12

Fort Wayne Surgeons team up to save More than 300,000 boy with rare traumatic injury. West Lafayette PATIENTS TREATED ANNUALLY Lafayette

Muncie

Fishers Carmel PRIMARY SPECIALTY Richmond Connor Guthrie doesn’t remember much about the performed by Dr. Landman and IU Health University Hospital Indianapolis CARE CARE accident. What he does remember is the excruciating pain. thoracic surgeon Kenneth A. Kesler, MD. The complex 200 + 400 Avon The injuries to Connor’s abdomen, stomach and esophagus reconstruction rarely used on a child involved turning the

Greensburg from a car crash in Bloomington were so severe they stomach into a tube and bringing it up to connect to the physicians across 40 specialties Terre Haute Columbus required the combined skills of surgeons at Riley Hospital repaired esophagus. Bloomington for Children and IU Health University Hospital to repair. Though the tube The boy’s esophagus had ruptured where it connects to will grow with the stomach, tearing a hole and spilling the contents of “It was one of the more Two pediatric hospital Connor, he will the stomach into his abdomen. complex injuries I’ve ever locations in central Indiana: always have to be seen. Complex in how it first “I admit when the Bloomington trauma team told me careful how much Evansville/Newburgh the injury they thought Connor had, I didn’t believe it he eats at one presented, how we had to ■ Riley Hospital for Children at IU Health – think about it immediately Indianapolis because it’s something you never hear about,” said time. Matthew P. Landman, MD, director, Riley Trauma after the injury; and then At 5 feet, 6 inches ■ Riley Hospital for Children at IU Health Services. how we had to proceed with North Hospital – Carmel and barely 90 Riley Hospital for Children “When Connor got to Riley, he was awake but was in a lot pounds, Connor is reconstruction.” at IU Health is a Magnet® of pain, and it was very clear immediately that he would thin but healthy. Matthew P. Landman, MD Director, Trauma Services hospital, recognized for need an operation,” Dr. Landman said. “We took him to the He tried out for AFFILIATED WITH nursing excellence and high- OR urgently and found a very unusual perforation of his the basketball quality clinical outcomes stomach as the esophagus comes from the chest into the team at school abdomen. It’s exceedingly rare.” but was cut after the second So rare, in fact, that Dr. Landman had never seen it in round, mostly, he an actual patient. ■ One of the largest medical schools in the U.S. believes, because Leader in research “It’s one of those things you read about, you learn how his stamina is ■ One of the busiest locations for pediatric not yet what it research funded by the National Institutes of and innovation to take care of it, then you never see it. And here it was on our doorstep.” needs to be. His Health and other sponsors ■ Indiana’s only pediatric mom, Amber Riley Children’s Health and IU School of Medicine research hospital Initially, Dr. Landman Hattabaugh, is are committed to providing excellent healthcare chose to correct the proud nonetheless. ■ Sixth-ranked children’s hospital for children through prominence in education, problem by stapling in U.S. for research funding off the esophagus “For him to even be able to try out was a big deal,” she said. training and research. to prevent more Today, Dr. Landman said seeing Connor offers no hint of ■ Home to the Herman B Wells Center contamination what he’s been through. COMPREHENSIVE CHILDREN’S HOSPITAL AND HEALTH SYSTEM OF for Pediatric Research, in the abdomen. the Children’s Clinical Connor underwent “I got to see him go from being super sick, banged up and Research Center and subsequent bruised to being a normal kid again. Seeing someone come the Center for Children’s , including a from near death to living a productive life again, that’s an Health Services Research reconstruction surgery incredible honor to be a part of.”

2 | Riley Children’s Health Surgery Annual Report 2019 | 3 Riley Surgery at a glance Riley Surgical DEDICATED TEAMS IN 13 PEDIATRIC SURGICAL Research Day: Story of a Riley kid: SPECIALTIES COMPRISE RILEY SURGERY: Celebrating academic Ellie Griffith, age 9 ■ Cardiothoracic Surgery ■ Orthopedic Surgery achievement, innovation ■ Dentistry ■ Otolaryngology – Attended by nearly 300 perioperative Skillful urologic surgeries Head & Neck Surgery team members, the third annual ■ Interventional Cardiology Surgical Research Day at Riley Hospital make full life possible. ■ and Electrophysiology Pediatric Surgery for Children at IU Health took place on ■ ■ Plastic Surgery May 15, 2019. The conference included 50 abstracts highlighting clinical and ■ Maternal Fetal Medicine ■ Transplant Surgery basic science research within Riley at Helen “Ellie” Griffith is used to making her way around Riley Hospital IU Health perioperative services. All ■ Neurosurgery ■ Urology for Children. She’s been doing it for years. When Ellie was born, she surgical specialties, and was diagnosed with bladder exstrophy, a rare ■ Ophthalmology nursing were represented. condition in which the bladder develops outside Jeremy L. Herrmann, MD, and Riley of the body. She also had PELVIS syndrome, Cardiothoracic Surgery received the Best characterized by a perineal hemangioma More than More than Oral Presentation award for their work, that formed inside her body, affecting her 90 250 “Long-term Outcomes of Neonatal Patients urinary system. At just nine months old, SURGEONS AND SURGICAL TEAM Undergoing Aortic Switch Operations for Ellie underwent her first surgery, performed by urologic surgeon ANESTHESIOLOGISTS MEMBERS Richard C. Rink, MD, to address the problems. TGA.” Riley Plastic Surgery earned Best Poster Presentation for “Safety and Trends “We got a phone call from Dr. Rink to come into the office, and it turned in Ketorolac Use During Cleft Palate Repair: out that the routine from Ellie’s surgery showed that she had An Examination of the Pediatric Health embryonal rhabdomyosarcoma of the bladder (cancerous bladder),” said More than Information System (PHIS) Database.” Ellie’s mom, Jamie Griffith. “It was really hard news to take—it had already 19,000 been a very long nine months and then to have a cancer diagnosis on top SURGICAL PROCEDURES Stacy M. Nance, RN, received the Best of it, it was horrible just trying to figure out how to deal with it.” PERFORMED IN 2019 Nursing Research award for her work, “Feeding and Activity Restrictions After With expert treatment by Riley oncologists and support from the care Infant Cleft Palate Repair: A Survey of team, Ellie completed 48 weeks of chemotherapy before undergoing a North American Cleft Programs and second surgery. Evaluation of Online Content Availability.” “Dr. Rink was able to take out the entire bladder, which made the As the nursing research award winner, difference in her survival,” Jamie said. “I feel like he saved her life because 11,301 Nance received funding from Riley he was able to do that.” 2019 6,735 19,064 Children’s Foundation to further her 1,028 research. For the third consecutive year, After the surgery, which included an ostomy, Ellie finished her course of Riley Anesthesia was recognized for chemotherapy. Following the successful cancer treatment, Ellie’s parents 11,259 knew they wanted to help their daughter be more independent, so when 2018 6,536 18,652 submitting the most abstracts. 857 Ellie was 4, they turned once again to Dr. Rink. Keynote speaker Lynn “He went back in and completely reconstructed her urinary system and Martin, MD, MBA, (left) 11,022 presented “Operative made it all internal so now she has a catheterizable channel into a 2017 6,725 18,619 bladder made of bowel,” Jamie explained. “She’s just like any other kid 872 Services Outcome on the outside.” Improvement Using Toyota (LEAN) Methods,” Ellie, who’s now 9 years old, is grateful for all the things she’s able to do. 10,287 2016 6,931 18,080 challenging attendees to think differently “After I had my last surgery, I was able to swim and stuff and after a while 862 about operational effectiveness in the I was able to do taekwondo, and it was easier to do the things I like to do,” perioperative arena. Dr. Martin, an attending she said. 10,150 anesthesiologist, is the medical director of 17,952 2015 6,961 continuous improvement and innovation at Jamie credits the skilled surgical team and specialists at Riley for her 841 Seattle Children’s Hospital. daughter’s recovery and for the full life Ellie’s now able to live. Riley Hospital for Children at IU Health Riley Hospital for Children at IU Health North Hospital “Riley saved her life and gave her the opportunity to live it as fully as she Riley Outpatient Center Total can—and knowing her, I have no doubt it will be very full.”

4 | Riley Children’s Health Surgery Annual Report 2019 | 5 New maternity tower to feature unique, fully integrated care model

The Maternity Tower at Riley Hospital for Children at IU Health is scheduled to open in 2021. The facility centralizes all of Riley’s obstetric and neonatal care across Method Tuuli, MD, co-medical director, the Riley Hospital for Children and IU Health Methodist Hospital campuses. The maternity tower features a new coordinated care model anchored by the long- Riley Maternity and Newborn Health, standing reputation of Riley at IU Health for delivering expert care for complicated answers common questions from referring pregnancies and at-risk newborns. Riley, alongside our partners at IU Health, offers providers and patients about the program. comprehensive, multidisciplinary services and exceptional medical support to patients experiencing low- to high-risk pregnancies.

In March 2020, Riley Maternal Fetal Medicine relocated to the Riley Outpatient Q: How is Riley’s care model different? Center, expanding its footprint with additional private exam rooms and ultrasound suites. The Riley Fetal Center is housed in the same area and includes a “nesting Dr. Tuuli: One of the overarching benefits of our program is the true integration of , maternal fetal medicine and room” for patients to relax between appointments and testing. neonatology care. While collaboration between OB and neonatology exists in most health centers in Indiana and across the country, Riley’s care model is integrated both operationally and physically in our children’s hospital. This allows us to deliver services in a seamless manner from initial consultation and maternal and fetal assessment to delivery planning—and Riley Fetal Center Maternity Tower at Riley Hospital for Children finally, to management of labor and delivery. For babies needing immediate, high-level care, our pediatric subspecialists are The Riley Fetal Center provides preeminent Expertise and services available on site, with no need for transport, resulting in consistently better patient outcomes. management of a broad range of complex ■ Most comprehensive obstetrics and maternal fetal medicine and high-risk conditions, while supporting program in the state Q: How will Riley ensure quality care for mothers? families with coordinated care specific to the ■ High-risk pregnancy consultation and services for women with Dr. Tuuli: We are committed to providing high-quality, safe care for all mothers delivering at Riley. While our maternity needs of the patient. medical and obstetrical issues services are located in a children’s hospital, our program is closely aligned with IU Health adult services. Our obstetrics

■ ■ Advanced fetal imaging, including On-site Level III and Level IV NICUs intensive care unit will be covered 24/7 by an adult intensive care , and both adult and pediatric experts from echocardiography, extensive – Riley’s combined Level III and Level IV NICU is the largest NICU throughout the IU Health Adult Academic Health Center will be on call day and night for consultations at Riley, if needed. ultrasonography and the state’s only in Indiana and among the largest in the country fetal MRI Q: Why should women with normal or low-risk pregnancies also consider delivering at Riley? ■ Specialty maternal fetal medicine programs: ■ Personalized, multidisciplinary and family- – Mood Disorders Program (collaboration with IU Health ) Dr. Tuuli: Being equipped to manage the highest risk cases means we’re more than prepared to take care of mothers centered care consultations with families experiencing normal pregnancies. Complications during labor and delivery are unpredictable and occur even in pregnancies – Maternal Recovery Program (women recovering from substance and support team members abuse disorders) that are considered low risk. Which mother, for example, is going to bleed heavily after delivery? Despite extensive ■ Multidisciplinary fetal care conferences, knowledge of risk factors, OB physicians still predict very few of these. Our expertise in managing complex pregnancies – Centering Pregnancy Program (group prenatal care) bringing together more than 40 Riley makes Riley the safest place even for low-risk patients because of our ability to skillfully respond at the highest level to specialists, to discuss best practices – Programs for pregnant women with medical conditions such unexpected complications that can happen. and management plans for complex as diabetes and cardiac disease fetal diagnoses ■ General pregnancy care, including experienced obstetricians We’re also excited about our new midwifery program, an alternative for women who want a more natural labor and delivery and midwifery program experience but also desire the security of a hospital setting. Our certified nurse midwives provide patient-centered care for women through pregnancy, birth, postpartum and beyond.

Maternity tower These images are renderings only. The final product may differ slightly.

The tower includes: ■ 45-bed Level III NICU ■ Labor/delivery birthing suites (private rooms) ■ 68 private postpartum rooms ■ Obstetrics intensive care unit for mother and baby With 105 total NICU beds (new Level III NICU plus existing 60-bed Level IV NICU), Riley at IU Health houses the largest NICU in the state.

6 | Refer a patient: 317.944.7010 (Maternal Fetal Medicine | Riley Fetal Center) Riley Children’s Health Surgery Annual Report 2019 | 7 Cardiothoracic Surgery Nationally recognized treatment Our specialists are recognized nationally and internationally as RANKED 5th Home to one of the nation’s leading pediatric heart respected resources for complex procedures that repair undersized IN THE NATION centers, Riley Hospital for Children at IU Health pulmonary arteries, remove cardiac tumors and rebuild complex heart provides the expertise, experience and resources to anatomies. We also have a full complement of ventricular assist devices to support the function of a failing heart, including the total artificial care for infants, children and adults with congenital heart. In fact, Riley at IU Health was one of the first pediatric programs or acquired heart disease. Achieving exceptional in the U.S. to give a child a Berlin heart. outcomes year after year, the board certified surgeons in our cardiovascular and cardiothoracic surgery Committed to innovation and excellence program treat and manage the entire spectrum of Practicing at the highest level of board certification, Riley heart surgeons heart defects—from the most common to the most have an extra tier of training and practice in congenital heart defects rare and complex. and thoracic disease. These credentials set them apart as a rare breed DIVISION CHIEF of surgeons offering a degree of expertise found only in the most Mark W. Turrentine, MD Specialized, integrated pediatric heart care advanced pediatric hospitals. Program leader since 2014 Offering a fully integrated program to care for children and adults with John W. Brown Professor of Cardiothoracic congenital heart disease, we attract patients from Indiana, the United States The team’s pursuit of excellence also keeps them invested in research Surgery, IU School of Medicine For full team member list, see page 38. and many parts of the world. With a variety of resources, our high-volume to find new ways of resolving complex congenital heart defects and program is organized and ready to provide a rare level of coordinated care diseases of the lung, blood vessels and heart. Our surgeons share their knowledge globally through lectures and humanitarian work that at one of the nation’s top destinations for acute care. Program distinctions promotes children’s heart health. The Riley pediatric heart team is comprised of world-renowned specialists Ranked among the top five trained in cardiovascular and cardiothoracic surgery, cardiac anesthesiologists, imaging technicians, congenital cardiologists, pediatric heart programs by cardiovascular intensive care specialists, dedicated cardiovascular nurses and many others who specialize in working with U.S. News & World Report heart defects and thoracic conditions. As part of a comprehensive pediatric healthcare system for advanced care, our team collaborates with other highly skilled specialists to deliver the right care at the right time. Nationally known as a high-volume center for the Ross procedure, The Riley at IU Health Adults with Congenital Heart Disease Program manages a child’s condition into adulthood to promote a surgery that uses a patient’s optimal health through every stage of life. In addition, families affected by congenital heart disease linked to their genetic pulmonary valve to replace the traits can also seek guidance from our Cardiovascular Genetics Program to determine whether future children or other family aortic valve members may be at risk for the same disorder. Part of a select group of hospitals in the U.S. certified to perform pediatric heart transplants

Highest rating from the Society of Thoracic Surgeons Operative and Adjusted Operative Mortality Postoperative Length of Stay 47.5 The Society of Thoracic Surgeons Source: Society of Thoracic Surgeons (STS) | Congenital Heart Surgery Data Summary, Table 16 Source: STS Benchmark Operations Table 18 Norwood 49.8 July 2015 – June 2019. Note: Most recent data available as of Aug. 1, 2020. for STS Data Harvest | July 2015 – June 2019 (STS) hosts the largest pediatric Truncus 27.5 Riley STS hospitals 28.7 congenital heart database in the # DEATHS/ OBSERVED EXPECTED 16 NEONATES/INFANTS/ STS ASO + VSD ELIGIBLE MORTALITY MORTALITY 20.4 world, which includes participants CHILDREN/ADULTS OVERALL from more than 95% of U.S. RILEY RILEY RILEY 16 ASO 17.3 hospitals performing congenital heart All STAT Mortality Riley patients return 9 Categories 30/1,380 2.2% 3.7% 2.7% Fontan surgery. The STS star rating system home an average of 13.5 9 is one of the most sophisticated Glenn/ STAT Category 1 4/424 0.9% 0.4% 0.4% four days sooner Hemi fontan 14.2 and highly regarded measures of (Least complex) 9 than the STS national AVC 16.6 overall quality in healthcare. The STAT Category 2 6/374 1.6% 1.8% 1.4% median across 10 TOF 7 highest possible rating is three stars, 11.7 which denotes lower than expected procedures, with Off by-pass 7 STAT Category 3 2/195 1.0% 1.6% 2.2% coarctation 12 accordingly better mortality with the highest category 5 VSD 9.1 of quality. Riley at IU Health is one STAT Category 4 17/329 5.2% 9.1% 6.1% overall mortality. of only seven programs to earn the 0 10 20 30 40 50 prestigious three-star designation. STAT Category 5 (Most complex) 1/58 1.7% 15.8% 13.3%

8 | Refer a patient: 317.944.7150 (heart) | 317.944.2394 (lung or throat) Riley Children’s Health Surgery Annual Report 2019 | 9 Dentistry 0 0 Care coordination for complex needs Riley pediatric dentists, faculty members of Indiana University School of Dentistry, have years of experience 15,000 Riley dentists treat children with complex medical 14,922 15,000 providing comprehensive dental care to children of all 14,378 14,339 conditions, including physical disabilities, ages, including those with special healthcare needs. We offer a full range of pediatric dental services, craniofacial anomalies, genetic disorders, liver and 10,000 including sealants, restorations, fluoride and limited kidney disease, and patients with congenital and orthodontics for children and adolescents. In our advanced, 12-chair dental facility, the skilled dental acquired heart problems. We work closely with team and expert pediatric anesthesiologists from Riley 5,000 Riley specialists to optimize outcomes for these at IU Health administer sedation and general anesthesia medically compromised patients. DIVISION CHIEF for children, including those with special needs such Brian J. Sanders, DDS, MS as developmental, emotional, behavioral or cognitive Program leader since 1999 0 impairments. 0 0 0 0 Chair of Pediatric Dentistry, IU School of Dentistry For full team member list, see page 38.

Program distinctions Our pediatric dentists collaborate with Comprehensive dental care for children of all ages, other Riley at IU Health specialists such including those with special as oral surgeons, otolaryngologists, medical needs ophthalmologists and plastic surgeons Treatment for patients with to manage conditions and improve complex medical conditions children’s health. 24/7 coverage for dental emergencies

Pediatric trauma care Riley at IU Health dentists provide 24/7 emergency coverage for children suffering from dental trauma or other emergencies.

Early intervention and preventive dental care Research and training Children should see a dentist when their first tooth erupts into the mouth or by the age of 1 year. Though In addition to providing compassionate care, this may seem early, we see the best outcomes for Riley dentists are dedicated to improving dental health when children receive dental care at this pediatric dentistry through education and age. With early intervention, pediatric dentists are able research. Our dentists conduct research to to identify and diagnose any dental development issues advance children’s dental health and train dental before they become serious problems. Our pediatric students and pediatric residents how to manage dentists also teach parents how to care for their child’s children’s dental care and use the latest treatments. teeth and offer guidance about brushing, foods to avoid Working with patients under the supervision of and general dental care. Early childhood visits can prevent dental issues or complicated surgeries later in IU School of Dentistry faculty, residents at Riley a child’s life. receive hands-on training.

10 | Refer a patient: 317.944.3865 Riley Children’s Health Surgery Annual Report 2019 | 11 Interventional Cardiology Electrophysiology Riley at IU Health pediatric electrophysiologists treat patients with and Electrophysiology various arrhythmias, often during ablation procedures that abolish the focus of an arrhythmia or by implantation of a pacemaker or Board certified and fellowship trained, Riley at IU Health implantable defibrillator. These sophisticated methods provide RANKED 5th IN THE NATION interventional cardiologists diagnose and treat congenital treatment for conditions such as supraventricular tachycardia (SVT), heart defects from the simple to the most complex. ventricular tachycardia (VT), ventricular fibrillation for history of sudden Specially trained to perform the latest invasive, catheter- cardiac arrest and Wolff-Parkinson-White (WPW) syndrome. based procedures, our experienced and skilled pediatric Electrophysiology procedures performed at Riley at IU Health: cardiologists are available to consult with referring physicians regarding indications for and timing of ■ Mapping of arrhythmia-causing electrical pathways

these procedures. ■ Radiofrequency and cryoablation of abnormal bypass tracts DIRECTOR causing arrhythmia (for SVT, VT and WPW) Mark H. Hoyer, MD Interventional cardiology ■ Implantation and revision of implantable permanent pacemakers Program leader since 2000 As part of a comprehensive interventional cardiology and defibrillators Professor of Clinical , IU School of Medicine program, our cardiologists provide essential anatomic ■ Implantation and removal of loop recorders used to detect For full team member list, see page 38. evidence during diagnostic procedures to direct cardiovascular surgical possible arrhythmias interventions. In addition, they repair heart defects, such as patent ductus arteriosus (PDA), atrial septal defect (ASD) and ventricular septal defect (VSD), Program distinctions that allow both children and adults to avoid open heart surgery altogether. Ranked among the top five The interventional cardiology team collaborates with Riley cardiovascular surgeons to perform “hybrid” procedures either in pediatric heart programs by the operating room or the catheterization suite to overcome challenging situations such as device closure of muscular VSDs U.S. News & World Report with transesophageal echo guidance; open sternotomy in the catheterization lab to implant stents in the PDA for infants with hypoplastic left heart syndrome; or open chest to help provide more direct approach for balloon angioplasty or stent implantation. Active in clinical trials to provide the latest treatment options Our team performs a variety of interventional cardiology procedures, including: Partner in performing “hybrid” ■ Balloon pulmonary and aortic valvuloplasty ■ Device/coil occlusion of: procedures to address complex ■ Balloon angioplasty of aortic arch, branch pulmonary – Venous or arterial collateral vessels heart conditions arteries, conduits and venous obstructions – Coronary fistulas and pseudoaneurysms ■ Balloon atrial septostomy (often for transposition ■ Stent implantation in aorta, pulmonary arteries and of the great arteries) obstructed veins ■ Recanalization of occluded venous pathways ■ Creation or enlargement of ASD or Fontan fenestration ■ Device closure of: ■ Transcatheter implantation of pulmonary and tricuspid valves – PDA, ASD, VSD, patent foramen ovale (PFO) ■ Hybrid procedures in collaboration with cardiac surgeons and Fontan fenestration ■ Pericardiocentesis – PDA in premature infants weighing even less ■ Vascular access from femoral, jugular, subclavian and than 1,000 grams Interventional Cardiology and transhepatic routes 00 0 Electrophysiology Procedures: 2019

750 2% Electrophysiology only Interventions by Type: 2019 640 650 100 634 13% Electrophysiology ablation 576 87 558 511 495 502 75 500 455 443 44% 13% Biopsy/Treatment Interventional cardiology 51 50 24% 44 Diagnostic 4% Pacemaker/Implantable cardioverter-defibrillator (ICD)

30 30 250 25 00 0 0 0 0 05 0 0 0 0 25 18 15 13 2 1 1 0 Balloon PDA Vascular ASD Stent Balloon Balloon Pulmonary Vascular VSD Fontan baffle PFO angioplasty closure occlusion closure implants valvuloplasty septostomy valve implant occlusion closure leak closure closure arterial (all) venosus 12 | Refer a patient: 317.944.8906 Riley Children’s Health Surgery Annual Report 2019 | 13 Interventional Radiology RILEY INTERVENTIONAL RADIOLOGY SERVICES*

Riley Interventional Radiology offers a wide range of minimally ■ Angiography and angioplasty ■ Nephrostomy tube invasive procedures to diagnose and treat many pediatric ■ Biliary drainage ■ Nephroureterostomy tube conditions. Through the expertise of our skilled interventional radiologists, our program minimizes the physical trauma associated ■ Biliary stent insertion ■ Paracentesis with open surgery and contributes to decreased infection rates, ■ Chest tube insertion ■ Percutaneous biopsy of shorter hospital stays and faster overall recoveries. Children benefit solid organs, bone and greatly from this approach to treatment, which often results in less ■ Cholecystostomy masses pain than standard procedures. ■ Cryoablation and microwave ■ Percutaneous drainage With preparation, procedure and recovery rooms together in ablation of vascular of abscesses and fluid malformations and tumors one location, our environment is specifically suited to treating collections DIVISION CHIEF Francis E. Marshalleck, MD pediatric conditions and caring for emotional needs. Our team ■ Dialysis angioplasty ■ Percutaneous stone retrieval Program leader since 2003 uses procedural sedation and surgical anesthesia to control pain. ■ Dialysis catheter Assistant Professor of Clinical Radiology and We also use tools that are smaller in size and made especially for ■ Peripherally inserted central Imaging Sciences, IU School of Medicine children. A trained child life specialist is available, when needed, to ■ Dialysis fistulagram catheter (PICC) For full team member list, see page 38.

support and calm children before and during procedures. ■ ■ Dialysis stent Port-a-cath

■ Program distinctions Advanced techniques and imaging ■ Double J ureteral stent Radiofrequency ablation of used to diagnose and treat osteoid osteomas Minimally invasive guided ■ Embolization Specially trained Riley interventional radiologists use X-ray, ■ delivers treatment with high gastrointestinal bleeding Sclerotherapy and computed tomography or ultrasound to see inside the body and embolization of vascular standard of quality and safety guide tools such as catheters, needles and stents to: ■ Embolization of varicocele malformations Advanced interventional radiology ■ Obtain biopsies ■ Embolization organ trauma ■ Suprapubic catheter suites offer low-dose technology, and tumors ■ Diagnose conditions minimizing risk and maximizing ■ Thoracentesis ■ benefit to pediatric patients ■ Stop internal bleeding caused by organ trauma or Gastrostomy tube, pelvis fractures gastrojejunostomy tube and ■ Triple lumen catheter cecostomy tube placement Interventional radiologists ■ Stop intestinal bleeding ■ Transhepatic and collaborate with Riley Vascular ■ ■ Treat Joint injection and translumbar central venous aspiration catheter Anomalies Program to treat – Blocked or damaged arteries or veins vascular malformations with – Tumors ■ Lymphangiography and ■ Tunneled central venous sclerotherapy and embolization embolization catheter – Urinary tract blockages

– Bile ducts that are blocked and damaged * Not an all-inclusive list of interventional radiology services – Joint pain

0 0

3,000 Riley interventional radiologists treat several specific conditions, including 2,390 2,361 2,000 2,261 vascular malformations, varicoceles, juvenile idiopathic arthritis, osteoid osteomas and liver tumors. Our

1,000 specialists also place catheters for children requiring long-term intravenous or fluids.

0 0 0 0

Note: Due to procedure code changes, volume numbers differ from those cited in previous reports.

14 | Refer a patient: 317.948.6328 Riley Children’s Health Surgery Annual Report 2019 | 15 Maternal Fetal Medicine Riley Maternal Fetal Riley at IU Health Maternal Fetal Medicine offers comprehensive Medicine provides high-risk pregnancy consultation and services for women with leading-edge treatment medical and obstetrical issues, including preexisting diabetes, chronic and patient-centered high blood pressure, preeclampsia, preterm labor and other complex care for the following medical conditions that affect pregnancy. Our maternal fetal medicine conditions: specialists also care for women who experience unexpected problems Fetal conditions during pregnancy, such as early labor, bleeding or high blood pressure, Maternal conditions and provide care for newborns who may have birth defects or ■ Antiphospholipid syndrome ■ Amniotic band syndrome growth problems. ■ Asthma in pregnancy ■ Anencephaly

■ Cervical insufficiency ■ Bladder outlet obstruction Our program provides a wide range of multidisciplinary healthcare, DIVISION CHIEF ■ ■ Brain malformations and our team is available 24 hours a day, seven days a week. Nurses, Gestational diabetes Christina M. Scifres, MD Program leader since 2020 social workers and specialists meticulously coordinate evaluation, ■ Maternal acquired cardiac ■ Bronchopulmonary disease sequestration Associate Professor of Obstetrics diagnosis and treatment to help ensure a seamless experience for and Gynecology, IU School of Medicine the patient and family. ■ Maternal congenital heart ■ Congenital heart block For full team member list, see page 38. disease ■ Congenital pulmonary airway ■ Using targeted, advanced diagnostic tools, Preexisting diabetes malformation ■ ■ Duodenal atresia Program distinctions the Riley at IU Health Prenatal Diagnosis Program Prior stillbirth ■ Prior venous ■ Encephalocele Comprehensive care of pregnancies evaluates mothers and babies, and includes thromboembolism or deep ■ Hydrops complicated by maternal medical the following services: venous thrombosis conditions, including diabetes and Riley Fetal Center ■ Platelet alloimmunization ■ Abnormal placentation evaluation ■ Recurrent pregnancy loss cardiovascular disease ■ Pleural effusions Working closely with the Riley ■ ■ Amniocentesis Rheumatologic diseases ■ Pyelectasis/hydronephrosis Fetal Center, our maternal fetal ■ Riley Fetal Center supports ■ Substance abuse in pregnancy Extensive ultrasounds ■ Red blood cell preeminent management of a medicine specialists coordinate ■ Systemic lupus erythematous alloimmunization ■ Follow-up ultrasounds wide range of complex or high-risk care for pregnant women whose ■ Thyroid disease in pregnancy ■ Skeletal dysplasia fetal conditions ■ Multifetal pregnancy management fetuses are diagnosed with ■ Twin-to-twin transfusion ■ Preconception consultation congenital anomalies. The syndrome Maternal recovery program provides multidisciplinary center managed comprehensive treatment, ■ Preconception genetic counseling treatment for 256 referral patients Outpatient-Based Riley at IU Health maternal fetal medicine including opioid replacement ■ Prenatal blood tests therapy, counseling and group in 2019—56 more than in 2018. Opioid Treatment physicians provide outpatient treatment for ■ Prenatal genetic counseling prenatal care For more on the Riley Fetal Center, Program opioid-exposed pregnant women. In 2019, ■ Prenatal ultrasound refer to pages 6 and 27. our team treated 70 patients through this medical recovery program.

A leader in training 0 0 and research 15,000 Riley at IU Health offers 14,760 Indiana’s only maternal 12,464 fetal medicine fellowship to train 10,000 physicians in evaluating and treating complex pregnancies. In addition, our specialists in maternal fetal medicine conduct research aimed at improving 5,000 care in pregnancies complicated by preterm labor, diabetes and maternal opiate dependence. 0 0 0

16 | Refer a patient: 317.944.7010 Riley Children’s Health Surgery Annual Report 2019 | 17 CHAIR Neurosurgery Riley Neurosurgery is at the 2019 NEUROSURGERY CASE VOLUME 879 TOTAL Shelly D. Timmons, MD, PhD center of many of the hospital’s 2019 NEUROSURGERY CASE VOLUME 879 TOTAL Chair, Department of Neurological Surgery, Shunt surgery IU School of Medicine The skilled team of neurosurgeons at Riley at IU Health manages complex Spasticity surgery (baclofen pump placement) perioperative surgical homes and 17 Shunt surgery For full team member list, see page 38. Spasticity surgery (baclofen pump placement) brain, spine and nervous system conditions in children of all ages, from infants multidisciplinary programs: 17 to young adults. As one of the most highly skilled pediatric neurosurgery 20 Brachial plexus/peripheral nerve surgery teams in the United States, Riley neurosurgeons see patients from all over the ■ Adult spina bifida 20 Brachial plexus/peripheral nerve surgery Program distinctions world. Performing approximately 900 procedures annually, we routinely treat ■ Brachial plexus injuries/peripheral 31 Vascular (including endovascular procedures) Ranked among the top 25 the most complicated issues, including intractable epilepsy, skull and spine nerve disorders pediatric neurology and Vascular (including endovascular procedures) deformities, traumatic injuries, congenital conditions such as spina bifida, 31 neurosurgery programs by ■ Complex spine/scoliosis benign and malignant tumors, and blood vessel abnormalities in the brain. 34 Neuroendoscopic procedure U.S. News & World Report ■ Craniosynostosis/craniofacial Neuroendoscopic procedure deformities 34 We are committed to addressing any neurological need and partner closely 45 Chiari malformation decompression One of a limited number of with the neurology team and other colleagues at Riley at IU Health, including ■ Epilepsy Chiari malformation decompression hospitals nationally to offer specialists in and , neonatology, urology, neuro- 45 superior tertiary and quaternary ■ Movement disorders/spasticity oncology, cleft and craniofacial anomalies, otolaryngology, developmental 54 Spinal dysraphism repair care for children with severe pediatrics, , interventional neuroradiology, genetics, ■ Neuro-oncology 54 Spinal dysraphism repair neurologic injuries or illnesses orthopedic surgery, pediatric , and ■ 55 Craniosynostosis surgery Multidisciplinary pediatric and rehabilitation. To focus on providing specialized treatment for neurologic Craniosynostosis surgery ■ Traumatic brain injury/concussion 55 neurosurgery programs for disorders, our teams have developed a number of programs and centers of Epilepsy surgery ■ Vascular/stroke/moyamoya disorders 60 craniofacial anomalies, excellence, such as the comprehensive Epilepsy Program. neuromodulation, neuro-oncology 6 Laser interstitial60 Epilepsy thermal surgerytherapy procedure 10 Robot-assisted stereoencephalography placement and neurotrauma 6 Laser interstitial thermal therapy procedure 10 Robot-assisted stereoencephalography placement 63 Brain tumor surgery 63 Brain tumor surgery Using highly specialized equipment, Riley neurosurgeons offer minimally 72 Spinal instrumentation (by pediatric neurosurgery) invasive epilepsy surgery (featuring laser ablation of seizure foci) and 72 Spinal instrumentation (by pediatric neurosurgery) robot-assisted seizure surgery. In addition, our team has access to the 188 Shunt surgery latest clinical trials, providing leading-edge patient care to children and 188 Shunt surgery young adults with neurological conditions. Other neurosurgery procedures 240 Other neurosurgery procedures 240

Riley Neurosurgery uses the Donabedian model to evaluate quality of care. With the exception of same-day appointments, we strive for the lowest number possible.

JAN FEB MAR APR MAY JUN JUL AUG SEPT OCT NOV DEC 2019 2019 2019 2019 2019 2019 2019 2019 2019 2019 2019 2019 Leaders in research and innovation Process: Same-day appointments 27 17 13 19 8 11 20 21 13 15 23 23 Riley neurosurgeons and scientists are actively Process: Use of nonstandardized shunt valves 0 0 0 0 0 0 0 0 0 0 0 0 involved in research to advance understanding of why spine and brain disorders occur and to develop Outcome: Cerebrospinal fluid (CSF) leak 1 1 1 1 3 1 3 0 2 2 4 2 better operative and nonoperative treatments that are Outcome: Shunt infection 0 1 1 1 0 0 1 1 0 0 0 0 effective and safe for children. In 2019, our neurosurgery Outcome: Baclofen pump infection 0 0 0 0 0 0 0 0 0 0 0 0 team participated in 38 Institutional Review Board-approved studies to investigate: Outcome: Other surgical site infection 1 1 4 0 0 0 0 0 0 0 2 0 ■ Hydrocephalus Outcome: Readmission < 90 days 4 1 3 1 6 4 6 2 5 4 3 4 ■ Traumatic brain injury in pediatric patients

Structure: Overusage of OR block time 1 9 3 8 5 3 8 4 6 4 6 3 ■ Craniofacial anomalies

Number equals occurrences in each category. ■ Brain tumors

■ Spinal column shortening for tethered cord syndrome By adopting this framework for quality improvement in pediatric neurosurgery, we meet or exceed ■ national benchmarks for postoperative complications, such CSF leaks, shunt infections, baclofen Patient-reported outcomes pump infections, other surgical site infections and readmissions within 90 days of surgery. ■ Quality improvement

18 | Refer a patient: 317.944.6201 Riley Children’s Health Surgery Annual Report 2019 | 19 Ophthalmology 0 0

Offering comprehensive care and early detection for children with all varieties of Riley ophthalmologists 20,000 eye conditions and visual impairments, Riley Ophthalmology is the only program performed nearly 2,650 18,000 of its kind in Indiana. Our expert physicians treat a wide range of concerns from 16,000 18,267 vision problems remedied with only eyeglasses to complex conditions that require surgeries in 2019. 14,000 sophisticated surgical procedures. Our team is led by board certified, fellowship- 14,653 12,000 trained pediatric ophthalmologists who collaborate with pediatric optometrists and 10,000 certified ophthalmic technicians to offer the most advanced eye care available to children, as well as adults with strabismus. 8,000

Our ophthalmologists have detailed knowledge of children’s developing visual systems and can objectively evaluate children 6,000

of all ages and developmental stages, regardless of their ability to communicate what they see. 4,000 4,732 5,246 DIVISION CHIEF 2,000 David A. Plager, MD Comprehensive treatment for eye disorders 0 2018 2019 2018 2019 Program leader since 2000 Riley ophthalmologists evaluate, diagnose and treat New Established Professor of Ophthalmology, all types of eye conditions, including: IU School of Medicine For full team member list, see page 39. ■ Amblyopia (“lazy eye”)

■ Strabismus (eye muscle disorders) 0 ■ Pediatric cataract Program distinctions

■ Eyelid lesions, including ptosis, tumors, etc. Only group of board certified, fellowship-trained pediatric ■ Pediatric glaucoma 1% 2% ophthalmologists in Indiana ■ Ocular trauma 2% ■ Optic nerve diseases 2% The state’s only multidisciplinary ■ Refractive errors 5% programs for retinoblastoma 60% treatment, inherited retinal ■ Retinoblastoma and other ocular tumors 5% diseases and ocular genetics ■ Retinopathy of prematurity Seven ophthalmologists associated As part of a multidisciplinary team at Riley at IU Health, our eye specialists are trained to distinguish vision problems from with Riley (faculty members 9% learning problems, so we can direct children to proper care and treatment. In addition, Riley ophthalmologists partner with or fellowship alumni) have other departments, including neurosurgery, neurology, , hematology/oncology and developmental pediatrics served as president of the to evaluate and address the variety of ocular manifestations of many systemic conditions. These include Down syndrome, American Association for Pediatric 14% juvenile idiopathic arthritis, idiopathic intracranial hypertension, retinoblastoma and neurofibromatosis. Ophthalmology and Strabismus (more than any other program in the nation)

Pediatric eye evaluation, diagnosis and treatment require a different approach than adult care, and our team brings specialized skills and expertise to every child’s treatment plan.

Experts in pediatric ophthalmology Riley ophthalmologists train the next generation of pediatric eye specialists and hold national and international leadership positions in professional associations such as the American Academy of Ophthalmology, the American Association for Pediatric Ophthalmology and Strabismus, and the International Pediatric Ophthalmology and Strabismus Council. We are active in clinical trials that study new methods of diagnosis and treatment, and our ophthalmologists are widely published in peer-reviewed medical journals and texts used to train medical students, residents and fellows.

20 | Refer a patient: 317.944.8103 Riley Children’s Health Surgery Annual Report 2019 | 21 Orthopedic Surgery Skeletal malformations and congenital/ developmental conditions Treating infants and children of all ages, the pediatric Riley orthopedic specialists care for children of all ages with a wide orthopedic specialists at Riley at IU Health are range of skeletal malformations and congenital/developmental committed to ensuring children receive leading-edge, conditions. We use a variety of treatment methods, including guided- patient- and family-centered musculoskeletal care with growth procedures, external fixation devices and multiple-level superior outcomes. Our orthopedics program is a major osteotomies. Long bone lengthening is also possible for patients with regional referral center with a team of fellowship-trained leg length discrepancies. In 2019: surgeons who are internationally recognized as clinical ■ 104 patients under the age of 2 were treated using the Ponseti experts. Our specialists provide consultation, diagnosis technique for correction of clubfoot and treatment for a variety of orthopedic concerns. ■ 25 patients were treated with Bernese pelvic osteotomies DIVISION CHIEF Fractures, injuries and trauma ■ 18 patients diagnosed with developmental dysplasia of the hip Christine B. Caltoum, MD Riley at IU Health is the only children’s hospital in Indiana—and one of just a received open reduction treatment Program leader since 2019 few across the country—to be verified as a Level I Pediatric Trauma Center by Assistant Professor of Clinical Orthopedic Neuromuscular conditions the American College of Surgeons. In 2019: Surgery, IU School of Medicine Our physicians diagnose and treat a variety of orthopedic For full team member list, see page 39. ■ 394 patients transferred to Riley for inpatient care of fractures or musculoskeletal injuries complications related to neuromuscular conditions such as spinal ■ 231 patients received fracture care in our OR within 18 hours of admission for isolated femoral shaft fracture and deformities and gait abnormalities. These conditions include any supracondylar fracture of the humerus syndrome or disorder that impairs the functions of the nervous Program distinctions system or muscles, such as cerebral palsy or muscle disorders. Ranked among the nation’s top ■ 539 patients under the age of 14 received radiographically assisted reductions of both bone forearm fractures in the Emergency department pediatric orthopedics programs Riley Orthopedic Surgery uses the latest by U.S. News & World Report ■ patients received care for fractures or musculoskeletal injuries 2,236 diagnostic and surgical technology Scoliosis and other pediatric spine conditions EOS imaging – We use Indiana’s only EOS imaging machine for most Comprehensive musculoskeletal care—using the latest Riley orthopedic surgeons provide treatment for a variety of 05 0 patients who have conditions such as scoliosis, leg deformities or technological advances—for spinal deformities in patients from infancy to adolescence. leg length discrepancies. EOS provides patients with up to four times 1,500 children of all ages, infancy less radiation than other imaging services, an especially important Our innovative surgical techniques include the use of growing 1,485 through adolescence spine constructs such as the MAGnetic Expansion Control value to patients requiring many radiographic studies as part of their care plan. Primary care doctors can request use of the EOS imaging (MAGEC) rod, which minimizes spinal fusion, preserves spine A partner in providing superior motion and results in better patient outcomes. Riley at 1,250 machine whether or not the child is a patient of Riley at IU Health. 1,237 trauma care in the state’s only IU Health is the only location in Indiana to provide casting 1,190 1,168 Intraoperative O-arm – This surgical imaging system provides high- Level I Trauma Center for infantile or early-onset scoliosis. In 2019: 1,112 quality 2D and 3D intraoperative images of the anatomy and is ■ 127 patients were treated for surgical correction of 1,000 designed for use in orthopedic, spine and related surgeries. Holistic spinal deformity program, idiopathic scoliosis supported by a dedicated team of pediatric anesthesiologists, ■ patients were treated for surgical correction of Committed to research and innovation 89 features the latest advancements in neuromuscular scoliosis Our team is actively involved in a variety of surgical performance and 750 technology and postoperative care study groups, including IMPACCT, Pediatric Spine Study Group, Setting ■ 22 patients under the age of 5, diagnosed with infantile 05 0 0 0 0 scoliosis, were treated through Risser casting techniques Scoliosis Straight, Collaborative Orthopaedic Educational Research Group and Spinal Anesthesia for Clubfoot Patients. ■ Using a team-oriented, multimodal pain control protocol, 05 0 the average length of stay after spinal fusion for idiopathic scoliosis has decreased to an average of 2.1 days. 16,000 15,787 Pediatric musculoskeletal oncology program 1,5000 New locations and same-day access for urgent needs We provide the most comprehensive care in the state for pediatric orthopedic oncology, including tumors and nontumor 14,000 14,321 With plans for continued growth, the Riley orthopedic surgery team has conditions. Our orthopedic oncologists work closely with the 13,525 13,000 added locations to provide greater pediatric hematology/oncology team at Riley to provide world- 12,728 patient access. We currently see class care. In 2019: 12,000 12,208 patients at offices in Indianapolis, ■ 102 patients diagnosed with a malignant neoplasm Avon, Bloomington, Carmel and received treatment 11,000 Fishers. We also offer same-day appointments at select locations for ■ patients diagnosed with a benign neoplasm 199 10,000 patients with urgent needs. received treatment 05 0 0 0 0

22 | Refer a patient: 317.948.2550 Riley Children’s Health Surgery Annual Report 2019 | 23 Otolaryngology – A partner in patient-centered, interdisciplinary care Working closely with other Riley specialists to Head & Neck Surgery 0 coordinate excellent care, our otolaryngologists The expert team of fellowship-trained otolaryngologists at Riley are integral members of a number of provides the full range of pediatric ear, nose and throat care multidisciplinary programs: from common issues to more complex disorders. Our board Vascular Anomalies Program certified otolaryngology – head and neck specialists, as well The Riley at IU Health Vascular Anomalies Program as audiologists and speech-language pathologists, use leading- 3,922 provides high-quality, advanced care for children edge technology to perform extensive diagnostic evaluation of with vascular anomalies to help restore function and conditions and provide customized treatment. a more normal appearance. Children with vascular 5,892 Our team is committed to ensuring patients receive highly anomalies receive care from our multidisciplinary DIVISION CHIEF advanced head and neck care for the best outcomes. Riley team that includes board certified specialists in: Bruce H. Matt, MD, MSc otolaryngology specialists evaluate and treat a variety of Program leader since 1989 ■ Blood disorders Associate Professor of Otolaryngology – conditions, including: ■ Dentistry Head & Neck Surgery, IU School of Medicine For full team member list, see page 39. ■ Acute and chronic airway obstruction ■ ■ Chronic ear disease ■ Interventional radiology ■ Balance and dizziness disorders ■ Oral and maxillofacial surgery Program distinctions ■ Communication disorders ■ Otolaryngology – head & neck surgery First program in Indiana with ■ Cleft lip and palate fellowship-trained pediatric ■ Plastic surgery otolaryngologists ■ Head and neck masses ■ Physical therapy ■ Congenital ear anomalies Cochlear Implant Program Cochlear implant program ■ Hearing loss internationally recognized for The Riley at IU Health Cochlear Implant Program— ■ clinical care and research Salivary gland conditions an internationally recognized leader in cochlear ■ Nasal breathing problems implants and related research for children with Clinical partner in providing ■ severe to profound hearing loss—includes surgeons Sinusitis multidisciplinary care and and audiologists specially trained to treat all ■ Snoring, voice and sinus disorders support to children who are patients with cochlear implants. ■ Sleep apnea deaf or hard of hearing

■ Vascular anomalies Deaf and Hard of Hearing Clinic This specialized program is designed to support ■ Voice and speech conditions children through medical, social and educational Skilled Riley otolaryngology surgeons routinely perform thyroid care related to hearing loss. surgeries and surgical interventions for disorders involving the tonsils and adenoids. Cleft and Craniofacial Anomalies Program One of the largest and most experienced programs of its kind in the nation, the Cleft and Craniofacial Anomalies Program cares for more children with cleft lip and/or cleft palate than any other hospital in Indiana. For more on this program, refer to page 28.

Aerodigestive Program By providing multidisciplinary care to children with structural airway and functional gastroenterology disorders, this program strives to improve clinical outcomes. We coordinate outpatient evaluations and diagnostic and operative procedures, while conveying timely feedback to referring physicians and families for ongoing care.

24 | Refer a patient: 317.944.6467 Riley Children’s Health Surgery Annual Report 2019 | 25 Pediatric Surgery Our pediatric surgeons treat a variety of conditions:

Nine board certified pediatric surgeons at Riley at IU Health are experienced in ■ Appendicitis Expertise in providing performing the full spectrum of pediatric surgery. Our surgery team provides specialized care ■ Chest wall conditions 24/7, on-site surgical coverage, allowing for timely evaluation of children with – Pectus excavatum emergent and urgent surgical conditions. We also lead Indiana’s only pediatric Chest Wall Program at Level I Trauma Center, which annually serves more than 1,600 patients. – Pectus carinatum Riley Children’s Health For more on trauma services at Riley, refer to pages 36 – 37. – Poland syndrome Riley pediatric surgeons lead Our surgeons, anesthesiologists and clinical team – Slipping rib syndrome a multidisciplinary group of 0 members care for children of all ages and are ■ Colon and rectal surgery surgeons, anesthesiologists, pain committed to advancing techniques for improved – Imperforate anus specialists, physical therapists, recovery after surgery and limiting opioid use. nurses and child life therapists focused exclusively on the diagnosis – Hirschsprung’s disease DIVISION CHIEF We participate in multidisciplinary teams and treatment of pectus excavatum, pectus carinatum, Poland Alan P. Ladd, MD, MBA 3,570 and coordinate seamless care for even the – Anorectal abscess/fistula syndrome and other chest wall anomalies. We offer virtual visits for Program leader since 2020 most complex patients. In addition, Riley – Ulcerative colitis some postoperative follow-up to decrease travel time and improve the Professor of Surgery, IU School of Medicine 4,873 Pediatric Surgery continues to expand the – Crohn’s disease overall patient experience. For full team member list, see page 39. use of minimally invasive surgical techniques, – Familial adenomatous polyposis including thoracoscopy, laparoscopy and robotic Riley Fetal Center surgery, and therapeutic interventions, such as – Short bowel syndrome Riley surgeons are integral members of the multidisciplinary care Program distinctions extracorporeal membrane oxygenation (ECMO). ■ Gastroesophageal reflux team at the Riley Fetal Center. In addition to playing active roles Committed to quality and safety ■ Gastrostomy tube placement in prenatal consultation and multidisciplinary care management through methods that improve ■ Hypertrophic pyloric stenosis conferences, our surgeons are experts in performing a wide range of surgical recovery and limit opioid use Improving quality outcomes through research ■ Inguinal hernias, hydroceles and operations for complex congenital conditions. For more on the Riley undescended testes Fetal Center, refer to pages 6 and 16. The Riley pediatric surgery team has drastically reduced narcotic use Same-day appointments available through multimodal pain management strategies. Our one-month quality ■ Neonatal surgical conditions Center for Colorectal and Urogenital Health at Riley Hospital for Children improvement study of 38 patients with appendicitis (12 perforated) – Intestinal obstructions at IU Health for urgent referrals determined that despite these reductions, we were still prescribing more Riley at IU Health houses a multidisciplinary center to serve children – Congenital diaphragmatic hernia with complex colorectal and urogenital anomalies, including anorectal medication than needed. Based on these findings, Riley Pediatric Surgery Serves patients at 11 has implemented a program to educate providers and families. – Esophageal atresia and malformations, Hirschsprung’s disease, cloaca and exstrophy of locations in 10 cities tracheoesophageal fistula the cloaca, idiopathic constipation, colonic motility disorders, and across Indiana Laparoscopic appendectomy postoperative narcotic use – Omphalocele, gastroschisis other colorectal and urogenital conditions. The program provides – Necrotizing enterocolitis comprehensive care, coordinating multiple disciplines into a single Patients (N = 38) visit for a better patient experience. ■ Solid tumors

Average number of doses prescribed at discharge 9.0 ■ Trauma

■ Vascular access devices Average number used after 48 hours at home 1.8

Excess total number of doses in one month 297 South Bend Leading the way in basic science research Fort Wayne The Riley at IU Health Pediatric Surgery Basic Science Research Projected excess total number of doses in one year 3,564 SURGERY OUTREACH OFFICES Laboratory, under the direction of Troy A. Markel, MD, focuses on defining novel diagnostic tools and for neonatal intestinal West Lafayette disorders such as necrotizing enterocolitis and intestinal ischemia. The lab Muncie is funded for the next four years through the National Institutes of Health and Partners in global health Carmel the American College of Surgeons. Current studies focus on developing formula Riley pediatric surgeon Britney Grayson, MD, PhD, Indianapolis supplements that would reduce the risk for necrotizing enterocolitis in infants will join the pediatric surgery training program for whom breastmilk is not available. Other studies aim to bring novel machine Terre Haute learning technologies from the agrochemical and petroleum industries to the at Kijabe Hospital in Kijabe, Kenya. Columbus The hospital is one of the few sites in Bloomington healthcare market that would allow for the detection and treatment of necrotizing sub-Saharan Africa that provides training enterocolitis before it is clinically appreciated. The lab’s scientists hope to initiate in pediatric surgery. Dr. Grayson will serve clinical trials for these drugs and devices within the next year. in the program for two years. Evansville

26 | Refer a patient: 317.274.4682 Riley Children’s Health Surgery Annual Report 2019 | 27 Plastic Surgery Expertise in Our surgical specialists provide Hand and upper extremity The Riley at IU Health plastic surgery team, led by board certified plastic operative solutions and abnormalities: 2019 surgeons with fellowship training, provides a wide range of treatment for: ■ 248 surgeries reconstructive surgical care to children. Treating children across Indiana, our ■ Apert syndrome finger and thumb anomalies surgeons are committed to providing leading-edge, compassionate care to ■ 1,061 outpatient visits restore patients to their best selves. ■ Polydactyly

■ Syndactyly (hands and feet) Cleft and Craniofacial Anomalies Program ■ Thumb hypoplasia/aplasia ■ Cerebral palsy (part of a Approved by the American Cleft Palate-Craniofacial Association, the Riley at multidisciplinary team) IU Health Cleft and Craniofacial Anomalies Program is responsible for the ■ Thumb duplication ■ Brachial plexus palsies (part of ongoing care and treatment of nearly 2,000 children. Patients see specialists ■ Clinodactyly/camptodactyly a multidisciplinary team) DIVISION CHIEF in a variety of fields, including plastic surgery, neurosurgery, dentistry, ■ Cleft hand Gayle M. Gordillo, MD ■ Traumatic bony and soft tissue speech pathology, craniofacial orthodontics, oral and maxillofacial surgery, Program leader since 2020 ■ Amniotic band injuries developmental pediatrics, otolaryngology, audiology, nutrition, social work, Dr. Sanford and Thelma E. Glanz Professor ■ Arthrogryposis ■ Nerve and tendon of Plastic and Reconstructive Surgery, and care coordination. Specialized treatment is available for many IU School of Medicine ■ reconstruction craniofacial conditions: Radial club hand For full team member list, see page 39.

■ Cleft lip ■ Pierre Robin sequence Riley at IU Health Burn Center ■ Cleft palate ■ Midface hypoplasia and other The comprehensive pediatric burn center at Riley provides care for Program distinctions jaw abnormalities ■ Palatal fistulas Specializing in children with burns to all parts Home to Indiana’s only ■ Craniofacial syndromes ■ Acrocephalosyndactyly of the body. The inpatient unit comprehensive, multidisciplinary (Apert, Crouzon, Pfeiffer, Saethre- microvascular provides critical care, wound Pediatric burn center: 2019 cleft and craniofacial program ■ Hemifacial microsomia Chotzen, Muenke, Goldenhar, reconstruction management and rehabilitation ■ 22q11.2 deletion syndrome, Velopharyngeal dysfunction ■ Treacher Collins) Riley plastic and for children who have been 207 patient Pediatric burn center offers ■ Craniosynostosis reconstructive surgeons burned. With the help of nursing, consultations comprehensive inpatient and outpatient care The program is managed by fellowship-trained specialists certified by the are experts in the occupational therapy, physical ■ 289 outpatient visits American Board of Plastic Surgery. therapy, wound care and microvascular transfer of ■ 127 burn surgeries reconstructive plastic surgery, Skilled in treating children born skin, muscle and bone outpatient care assists patients in ■ 98 admissions with hand and upper extremity abnormalities Riley at IU Health plastic surgeons are authors of peer-reviewed flaps to reconstruct the transitioning back to normal life. scientific literature on craniofacial surgery and contribute to scalp, oral cavity, limbs research in the areas of Pierre Robin sequence, mandibular and other areas. Pediatric plastic surgery distraction, cleft lip and palate, and other conditions. Our highly trained team uses the latest surgical techniques to treat a wide range of conditions:

■ Ear anomalies (prominent ears, cryptotia, microtia, constricted ears)

■ Breast abnormalities 0 0 (macromastia, Poland 2,500 syndrome, constricted breasts, tuberous breasts, breast asymmetry, gynecomastia) 2,000 ■ Vascular anomalies 1,885 (hemangiomas, port wine 1,500 1,741 1,669 stains, venous and lymphatic malformations) 1,000 ■ Skin conditions (nevi, giant congenital nevi, melanoma,

500 tissue expansion, serial excision)

■ 0 Keloids and 0 0 0 hypertrophic scars

■ Laser therapy for scars

28 | Refer a patient: 317.948.0345 Riley Children’s Health Surgery Annual Report 2019 | 29 Transplant Surgery Specialized care, experience and exceptional outcomes are hallmarks of Our transplant surgical 50 IU Health Transplant at Riley Children’s Health. Our pediatric transplant team performs program is part of IU Health Transplant, a nationally recognized organ 40 transplant center that ranks among the top transplant centers in the U.S. transplants for many conditions: 36 by volume and is the largest, most comprehensive center in Indiana. 30 Kidney transplant Offering comprehensive transplant services for pediatric patients, our eight ■ Congenital diseases of the kidney 25 25 26 abdominal transplant surgeons perform kidney, pancreas, liver, intestine and urinary tract 20 21 18 and multivisceral (intestine along with two or more abdominal organs) – Dysplasia 16 transplants. While abdominal transplant surgery is not ranked by U.S. 10 – Obstructive uropathy News & World Report, each organ program contributes to the rankings DIRECTOR – Reflux nephropathy William C. Goggins, MD of Riley Children’s Health in the 0 0 0 05 0 0 0 0 Pediatric kidney transplant surgery ■ pediatric specialties of nephrology and Focal segmental glomerulosclerosis program leader since 2004 IU Health Transplant at * Includes pediatric kidney, pancreas, liver and intestine gastroenterology and gastrointestinal (FSGS) Associate Professor of Surgery, Riley Children’s Health surgery. ■ Glomerulonephritis IU School of Medicine ranks among the top Transplant programs have extensive federal oversight by the Centers for ■ Kidney tubular acidosis In collaboration with referring Medicare & Medicaid Services (CMS) and the Organ Procurement and 25 pediatric abdominal Transplantation Network (OPTN). All IU Health Transplant programs are in physicians and other Riley at IU Health ■ Nephrotic syndrome transplant programs compliance with CMS Conditions of Participation for Transplant Centers pediatric specialists, our transplant ■ Polycystic kidney disease and OPTN policies. in the nation based on surgeons determine the best course Liver transplant 2019 volumes. of treatment for each child. When a ■ Biliary atresia transplant is necessary, our abdominal A pediatric transplant surgery leader ■ Autoimmune liver diseases transplant team has the expertise to facilitate both routine and extremely Kidney ■ complex cases with excellent outcomes. The multidisciplinary team of Liver cancer ■ Indiana’s first pediatric kidney transplant in 1969 transplant surgeons, pediatric subspecialists, transplant coordinators, ■ Metabolic disorders ■ Largest kidney transplant program in Indiana OR teams, inpatient nurses, pharmacists, social workers, dietitians and ■ Acute/fulminant liver failure other professionals works together to support our pediatric patients and Liver ■ Cystic fibrosis their families before, during and after transplant. This level of experience, ■ Indiana’s first pediatric liver transplant in 1988 dedication and excellent clinical care translates to better outcomes for Intestine/multivisceral transplant* Pancreas DIRECTOR our patients. ■ Intestinal atresia ■ Indiana’s first pediatric liver-pancreas transplant in 2004 Richard S. Mangus, MD, MS ■ Midgut volvulus Intestine/multivisceral Pediatric intestine and liver transplant surgery ■ program leader since 2013 and 2015, Of 104 transplant centers in the U.S. in 2019 to perform pediatric Gastroschisis ■ Indiana’s first pediatric intestine transplant in 2003 respectively abdominal transplants, our program’s top 25 rankings include: ■ Necrotizing enterocolitis (NEC) ■ Indiana’s first pediatric multivisceral transplant in 2003 Professor of Surgery, IU School of Medicine For full team member list, see page 39. ■ Short bowel syndrome (SBS) ■ Intestine transplant volume: eighth in the nation ■ Hirschsprung’s disease ■ Liver transplant volume: 18th in the nation * IU Health Transplant at Riley Children’s Health Program distinctions is one of the few programs in the nation with ■ Kidney transplant volume: 25th in the nation Eight surgeons dedicated solely Medicare approval to perform pediatric intestine Our pediatric and multivisceral transplants. transplant surgeons to abdominal transplantation have transplanted more than 775 Home to the state’s only liver transplant and intestine/ abdominal organs multivisceral transplant programs since 1969. These surgeries are more Dedicated organ transplant unit than a number. They staffed by nurses specially represent lifesaving organ trained to care for pediatric transplants made possible transplant recipients through organ donation and the children who have received a second chance IU Health Transplant at Riley Children’s Health at a longer, healthier life. also includes the heart transplant program. For more information, refer to pages 8 – 9.

30 | Refer a patient: 317.944.4370 Riley Children’s Health Surgery Annual Report 2019 | 31 Urology Skilled in complex open, endoscopic and robotic urologic surgery, Riley urology Riley urologists treat a wide Coordinated care for surgeons specialize in treating conditions of the pediatric urinary tract (kidneys, variety of conditions, including: ureter, bladder) and genitalia. These conditions come in many forms—from complex medical needs ■ Bladder exstrophy and common pediatric and adolescent urologic problems to the most complex epispadias Our pediatric urologists and nurse practitioners are actively involved abnormalities affecting urogenital development. All of our surgeons are in numerous multidisciplinary programs to provide a wide range of ■ Congenital adrenal hyperplasia fellowship trained and board certified in pediatric urology services in collaboration with other Riley at IU Health physicians. RANKED 2nd IN THE NATION and are recognized leaders in the field. ■ Cloacal anomalies Each of these programs is unique, representing the only opportunity for patients in Indiana to receive coordinated care for these complex Known for expertise in complex genital reconstruction, ■ Hernias and hydroceles medical problems. Riley at IU Health is one of only four centers in the nation ■ Hydronephrosis designated as a Center of Surgical Excellence for surgical ■ Complex Voiding Dysfunction Center DIVISION CHIEF ■ Hypospadias reconstruction for children born with congenital adrenal ■ Refractory Bowel and Bladder Dysfunction Clinic (Sacral Rosalia Misseri, MD hyperplasia. Additionally, we are designated by the ■ Kidney stones Neuromodulation Clinic) Program leader since 2019 Professor of Urology, IU School of Medicine Association for the Bladder Exstrophy Community as one ■ Congenital Adrenal Hyperplasia Clinic ■ Labial adhesions/vaginitis For full team member list, see page 39. of 10 international Centers of Excellence for the care of ■ Disorder of Sexual Differentiation Clinic children with bladder exstrophy. ■ Neurogenic bladder ■ Spina Bifida Clinic As many of the conditions in pediatric urology have serious implications for ■ Phimosis and paraphimosis ■ Transitional Spina Bifida Clinic Program distinctions

children’s health and emotional well-being, Riley at IU Health has organized ■ Posterior urethral valves ■ Maternal Fetal Medicine Program Second leading pediatric urology multidisciplinary clinics with specialists to assist in managing complex patients. program in the nation as ranked ■ These include comprehensive programs to care for patients with spina bifida, Prenatal hydronephrosis and ■ Urology-Nephrology Stone Clinic urologic anomalies by U.S. News & World Report stones, prenatal urologic anomalies and differences in sexual development. We ■ Center for Urogenital and Colorectal Health

■ are internationally recognized for our transitional program, ensuring that children’s Undescended testes In addition to these multidisciplinary programs, Riley Urology provides Performs more pediatric urologic urologic needs are cared for appropriately as they become adults. surgeries (based on surgical case ■ Ureteropelvic junction care at 16 outreach offices across the state. volume) than any single children’s obstruction For every child’s care, our goal is to develop a treatment plan that addresses hospital in North America every aspect of health, personal development and quality of life, supported by ■ Ureterovesical junction experts from other medical disciplines who are part of our team. Because we obstruction Urology Distal hypospadias (N = 248) 98.2%* International leader in complex specialize in working with children, our child surgical reconstruction for urinary ■ Urinary tract infections Surgery life professionals are also ready to help Outcomes: incontinence in children with ■ Pyeloplasty (N = 60) 100%* spina bifida children understand and cope with difficult Vesicoureteral reflux 2019

procedures or simply reassure them during ■ Voiding dysfunction Telehealth resources provide 24/7 routine tests they may find frightening. Unplanned reoperation 0% access for perioperative care Our urologists are supported by The Riley Transitional Urology Clinic provides a team of more than 40 nurses * Successful surgeries without need for revision specialized services for patients requiring dedicated exclusively to pediatric lifelong care and follow-up after surgery, and urological care. is one of only two such clinical programs in the nation based in a children’s hospital. Committed to clinical research Riley Urology maintains the largest database in the 0 0 Urology Surgical Procedures: 2019 world for complex urinary tract reconstruction, including bladder augmentation with intestine, Mitrofanoff/Monti Hypospadias 247 bladder channels and MACE procedures. This allows us to

Surgery for vesicoureteral reflux continually monitor success and refine our techniques. 9,501 and ureteral anomalies 113 Our world-class team of urologists is academically productive in Robotic and laparoscopic all areas of urology, including four NIH-funded grants investigating 37,703 surgical procedures 110 patient-centered and long-term outcomes of robotic kidney Pyeloplasty 73 surgery, hypospadias and spina bifida. Our focus on clinical translational research is also supported by the Riley Children’s Major bladder Foundation. reconstruction 61

0 50 100 150 200 250

32 | Refer a patient: 317.944.8896 Riley Children’s Health Surgery Annual Report 2019 | 33 Anesthesia

The Riley Children’s Health anesthesia team delivers evidence-based, Anesthesiologists at safe, compassionate and value-based care to pediatric patients in all Riley at IU Health provide aspects of anesthesia, perioperative medicine, and acute and chronic pain management. Our team offers outstanding care and is also committed to comprehensive anesthesia leading innovative and personalized perioperative care research, providing services to approximately high-quality clinical education and improving health outcomes. 21,000 children each year. Dedicated to achieving the best outcomes, maximizing safety and minimizing discomfort, our multidisciplinary team of board certified pediatric anesthesiologists, anesthetists and nurse practitioners tailors equipment and protocols to meet children’s unique surgical care needs INTERIM DIVISION CHIEF and physiology. We continually improve the standard methods of clinical Leadership in pediatric anesthesia Adam J. Lemmon, MD Interim program leader since 2020 care based on the latest evidence and develop more effective, safe and ■ More than 55 anesthesia physicians, anesthetists, nurse practitioners and research nurses from top programs Assistant Professor of Clinical Anesthesia, reliable practices for protecting a child’s heart, lung and brain function, and IU School of Medicine blood circulation during anesthesia and medical care. ■ Largest (and still expanding) anesthesia programs for pediatric For full team member list, see page 38. acute and chronic pain management in the state Riley at IU Health anesthesiologists use dedicated pediatric experience, ■ Safe, leading-edge, evidence-based clinical care before, during clinical skills and expertise to safely deliver surgical anesthesia for pediatric and after surgery and procedures Program distinctions patients of all ages, from babies still in the womb to young adults. Largest anesthesia service in Indiana for pediatric surgery, Our anesthesiologists offer a wide range of services, including: Center for Anesthesia Research Excellence (CARE) The Riley Anesthesia research program, CARE, has three goals pediatric cardiovascular surgery, ■ Surgical anesthesia for all types of common pediatric surgical procedures, including outpatient surgery at Riley specific to the services we provide: neurosurgery and transplant surgery Hospital for Children at IU Health and IU Health North Hospital ■ To lead the research field in translating personalized anesthesia ■ Anesthesia for complex surgeries in children, such as complex urogenital reconstruction, major neurosurgery, Recognized National Institutes and pain management research to clinical practice, as well as orthopedic surgery including spine fusions, congenital heart surgery, and craniofacial pediatric anesthesia safety and outcomes research of Health and industry-funded reconstruction pediatric anesthesia/pain ■ To discover the mechanisms, physiologic and clinical elements management research programs ■ Anesthesia management for diagnostic and therapeutic procedures, including MRI, CT scanning, interventional of pediatric anesthesia and pain management, and to translate aimed at improving clinical outcomes radiology, gastrointestinal endoscopies, radiotherapy, vesico-urethrogram and cardiac catheterization into clinical practice

■ ■ Acute postoperative pain management, including standardized, protocol-driven epidural, spinal, caudal and advanced To develop the next generation of clinical researchers in the field Only pediatric chronic and of pediatric anesthesia and pain medicine and developmental regional analgesia, as well as patient-controlled analgesia medical pain management neurobiology ■ Chronic pain management in children program in Indiana

■ Multidisciplinary consultation with surgeons and pediatricians Riley at IU Health clinical anesthesia sections The Section of General Anesthesia provides anesthesia before, ■ Preadmission anesthetic evaluation and testing, including preoperative consultations and instructions during and shortly after inpatient surgical procedures. The division provides multidisciplinary, coordinated care with a goal of better health and reduced cost of care. We accomplish this through 05 0 05 0 patient-centered decision-making and seamless continuity of

12,000 7,500 care from preoperative preparation and surgery through recovery, discharge and follow-up. 11,022 11,259 11,301 10,000 6,961 6,931 6,735 10,287 6,000 6,725 10,150 6,536 The Section of Cardiac Anesthesia provides anesthesia and pain

8,000 management for patients undergoing complex cardiac, thoracic or 4,500 vascular surgeries and procedures. 6,000

3,000 The Section of Pain Medicine makes surgical procedures in children 4,000 safe, comfortable and less painful. We provide excellent and cost- effective outcomes with an interactive team approach to acute 1,500 2,000 pain treatment and chronic pain management with consultative and outpatient programs that tailor treatment options to individual 0 0 05 0 0 0 0 05 0 0 0 0 patient needs.

To refer a patient to the pediatric pain management program, call 317.944.2353.

34 | Riley Children’s Health Surgery Annual Report 2019 | 35 Trauma Services In 2019, 51% of all trauma cases came Riley Hospital for Children at IU Health provides 24/7 trauma care to directly to Riley at evaluate and treat the most severely injured pediatric patients. In our Level I Pediatric Trauma Center, experienced pediatric surgeons, emergency IU Health from the scene medicine physicians, anesthesiologists, critical care physicians and other of the injury, while 49% healthcare professionals work collaboratively as a team, taking decisive of children in need and rapid action to provide effective treatment in critical situations when seconds matter. of trauma care were

More than 80% of all injured children arrive at Riley during the evening or at transferred from other night, making our 24/7 in-house coverage by pediatric specialists essential. hospitals in the state Children’s Surgery Our trauma services team is ready for any scenario with four trauma bays and region. DIRECTOR in the Emergency department and an operating room always available for Verification Matthew P. Landman, MD incoming critical cases. Program leader since 2020 Assistant Professor of Surgery, IU School of Medicine Level I Pediatric Trauma Center since 1992 Quality improvement benchmarks for pediatric trauma Verified by the American College of Surgeons (ACS) as a Level I Pediatric Trauma The American College of Surgeons trauma quality improvement Center, Riley at IU Health is one of a select number of children’s hospitals in the benchmarking is risk based and allows comparison of patient nation to earn this designation. The hospital requested the verification, with an on- outcomes with other trauma centers across the nation that care for site review conducted by an ACS team of reviewers experienced in trauma care. pediatric patients. The ACS cited the robust quality improvement This verification program for hospitals, established by the ACS in 1987, promotes the development of trauma centers in process for injured children at Riley as one of many strengths of our which verified centers provide not only the hospital resources necessary for trauma care, but also the entire spectrum of care hospital trauma program. to address the needs of all injured patients from the prehospital phase through rehabilitation, as well as injury prevention.

Pediatric traumatic brain injury and concussion program INDICATOR RILEY NATIONAL DATA The Riley Traumatic Brain Injury and Concussion Program, the first Median injury severity score 5 5 and only program of its kind in Indiana, facilitates a multidisciplinary, Blunt splenic injury with splenic team-based approach to the care of infants, children and 97.6% 95.1% adolescents with concussions and other traumatic brain injuries. preservation Care is provided by specialists in: Time to operative fixation of mid- 4.2% 7.1% PROGRAM MANAGER ■ shaft femur greater than 24 hours Neurosurgery Dawn M. Daniels, PhD, RN, PHCNS-BC ■ Time to intracranial pressure Physical medicine and rehabilitation 1.9 hours 2.9 hours Program manager since 2012 (ICP) monitoring For full team member list, see page 39. ■ Neuropsychology Time to craniotomy 1.9 hours 1.9 hours Riley physicians and other medical professionals continue to discover more about the complexities of concussions, including which patients are susceptible, why concussions occur, how problems develop and the role of healthcare providers in helping Riley at IU Health outperforms national benchmark for these indicators. to ensure good outcomes. Program distinctions Only Level I Pediatric Trauma Center in Indiana 0 0 00 0 2,000 1,899 Recognized by the American

22% 1,665 College of Surgeons review 1,559 1,590 committee for robust quality 1,600 1,462 1,381 years of age improvement review 1,241 1,196 1,200 37.3% 26% 1,038 1,041 8% Experienced pediatric trauma 909 surgeons, pediatric critical care years of age Increasing recognition by referring physicians, 800 years of age parents and others that children should be physicians and anesthesiologists 22.7% 33% treated by pediatric specialists contributes available in-house, 24/7 year 19.0% 5 9% years of age 400 to continued growth in the number of injured and older 12.7% 1% children treated at Riley at IU Health. 8.3% 1% 0 00 00 0 0 0 0 05 0 0 0 0

36 | Riley Children’s Health Surgery Annual Report 2019 | 37 Riley Surgery Team Member Directory

Surgeon-in-Chief Justin Ellingworth, CAA Jennifer Dildine, RN Ophthalmology Pediatric Surgery Trauma Services Frederick J. Rescorla, MD Samantha Evankovich, CAA Jennifer Grossi, RN David A. Plager, MD Alan P. Ladd, MD, MBA Matthew P. Landman, MD Jennifer Rush, CAA Jenny Henson, RN Division Chief Division Chief Director Charline S. Boente, MD, MS Deborah F. Billmire, MD Thomas M. Rouse, MD Anesthesia Leah Snyder, CAA Meagan Hohlt, RN Associate Director Adam J. Lemmon, MD Mark Wheeler, CAA Dana L. Donaldson, OD Cartland Burns, MD Kathleen Jones, RN Dawn M. Daniels, PhD, RN, PHCNS-BC Interim Division Chief Molly Gerety, CRNA April L. Graves, OD Brian W. Gray, MD Lauren Lepper, RN Program Manager Rania K. Abbasi, MD Krysta R. Merritt, CRNA Kathryn M. Haider, MD Britney Grayson, MD, PhD Sandra Mosbaugh, RN Michael A. Acquaviva, MD April A. Jones, OD Matthew P. Landman, MD Urology Jacquelyn E. Allison, MD Alyssa Rogers, RN Daniel E. Neely, MD Troy A. Markel, MD Cardiothoracic Surgery Rosalia Misseri, MD Monica Sanborn, RN Gavin J. Roberts, MD Frederick J. Rescorla, MD Tanna Boyer, DO Mark W. Turrentine, MD Division Chief Heather A. Smith, MD Thomas M. Rouse, MD Elizabeth A. Collins, MD Division Chief Natalie Torres, RN Martin Kaefer, MD Derek T. Sprunger, MD Lauren Bates, CPNP Julie D. Dunlap, MD John W. Brown, MD Richard C. Rink, MD David K. Wallace, MD, MPH Trina Blunk, CPNP Brian N. Egan, MD Jeremy L. Herrmann, MD Interventional Radiology Joshua D. Roth, MD Stephanie Dunn, CPNP John D. Emhardt, MD Mark D. Rodefeld, MD Francis E. Marshalleck, MD Konrad M. Szymanski, MD, MPH Orthopedic Surgery Lori Miller, CPNP Thomas Feehan, MD Division Chief Benjamin M. Whittam, MD, MS Christine B. Caltoum, MD Julie Resler, CPNP Morton C. Green, MD Dentistry Sean Pfaff, MD Shelly King, NP Division Chief Lauren Yegerlehner, CPNP Matthew C. Hamilton, DO Brian J. Sanders, DDS, MS Christopher Sinsabaugh, MD Hillary Risk, NP Randall T. Loder, MD Doris M. Hardacker, MD Division Chief Jill Coss, FNP Sarah Acker, FNP Emeritus Professor Taylor Wang, NP Jeffrey A. Dean, DDS, MSD Megan Effnger, FNP Michele Hendrickson, MD Robert J. Bielski, MD Melissa A. Young, NP Nicole D. Horn, MD James E. Jones, DMD, MSD, EdD, PhD Kristine Nagle, FNP Maternal Fetal Medicine Tyler W. Christman, DO, MS LaQuia A. Vinson, DDS, MPH Matthew Hoyt, MD Christopher D. Collier, MD Juan F. Yepes, DDS, MD, MPH, MS, DrPH Christina M. Scifres, MD Plastic Surgery Gabe Krause, MD Ryan E. Fitzgerald, MD Division Chief Gayle M. Gordillo, MD Gopal Krishna, MD Robert G. Tysklind, MD Interventional Cardiology Mary Abernathy, MD Division Chief Stacy M. Kritzmire, DO Aaron G. Watters, MD Lauren Dungy-Poythress, MD Joshua M. Adkinson, MD Leigh B. Latham, MD and Electrophysiology L. Daniel Wurtz, MD Brett Hartman, DO Michael S. Mazurek, MD Diagnostic and Interventional Sherrine Ibrahim, MD Andrea N. Banet, PA Sunil S. Tholpady, MD, PhD William L. McNiece, MD Cardiac Catheterization Caroline Rouse, MD Amy L. Morton, PA William A. Wooden, MD Mark H. Hoyer, MD Robert G. Presson, MD Frank P. Schubert, MD Todd A. Osterbur, PA Director Eugene P. Presto, DO Anthony Shanks, MD Emily R. Thimling, PA Ryan D. Alexy, MD Transplant Surgery Senthil Sadhasivam, MD, MPH Susan Sherman, MD Michael M. Ross, MD Jonathan Fridell, MD Chansamone Saysana, MD Method Tuuli, MD Otolaryngology – Division Chief Electrophysiology Alex Serafin, MD Jennifer Weida, MD Head & Neck Surgery William C. Goggins, MD Aali M. Shah, MD Mark D. Ayers, MD Bruce H. Matt, MD, MSc Director, Pediatric Kidney Adam C. Kean, MD Division Chief Transplant Surgery George J. Sheplock, MD Neurosurgery Andrew F. Stasic, MD Congenital Cardiac Sarah J. Burgin, MD Richard S. Mangus, MD, MS Shelly D. Timmons, MD, PhD Director, Pediatric Intestine and Liver Clayre Tanis-Arens, MD Anesthesia Team Christopher M. Discolo, MD Chair, Department of Transplant Surgery Rania K. Abbasi, MD Elisa A. Illing, MD James A. Tolley, MD Neurological Surgery Burcin Ekser, MD, PhD Scott G. Walker, MD Matthew C. Hamilton, DO Ryan M. Mitchell, MD, PhD Laurie L. Ackerman, MD Chandrashekhar A. Kubal, MD, PhD Jian Ye, MD Doris M. Hardacker, MD Rick F. Nelson, MD, PhD Karl Balsara, MD Andrew Lutz, MD Michael S. Mazurek, MD Taha Z. Shipchandler, MD Kelsey Kmiecik, NP Plamen Mihaylov, MD Chansamone Saysana, MD Jeffrey S. Raskin, MD, MS Jonathan Y. Ting, MD, MS, MBA Marti Michel, NP John A. Powelson, MD Denise Ash, NP Lauren Parent, NP Scott G. Walker, MD Charles W. Yates, MD Elizabeth Schafer, NP Catheterization Lab Gloria Fritsch, NP Abideen O. Yekinni, MD Stephanie Whitacre, NP Lisa Bauermeister, RN Meredith Koontz, NP Allison R. Hammer, CPNP Elizabeth (Nikki) Block, CAA Rosemary Bland, RN Natasha Raman, NP Kristen S. Scheffel, CPNP Matthew DeBurger, CAA Ellen Coates, RN Jessamyn R. Salter, PNP, MSN

38 | Riley Children’s Health Surgery Annual Report 2019 | 39 Refer a patient

Riley Children’s Health cares for children in Indiana, across the nation Submit a referral online at Story of a Riley kid: and around the world. Same-day appointments are available for some rileychildrens.org/refer. providers. To schedule an appointment or to speak with a surgical Noah Howard, age 10 specialty administrator, please call:

Complex surgery relieves SPECIALTY PHONE NUMBER life-threatening seizures. Cardiothoracic Surgery 317.944.7150 (heart) 317.944.2394 (lung or throat)

Dentistry 317.944.3865

Noah Howard was just 17 months old when Riley surgeons fewer complications than a hemispherectomy, which Interventional Cardiology and Electrophysiology 317.944.8906 removed a grapefruit-sized tumor from his brain, saving involves physically removing the brain tissue. his life. Nine years later, he was back at Riley for another Interventional Radiology 317.948.6328 “In the early days of neurosurgery, they removed the whole surgery—a functional hemispherotomy, a rare neurological Maternal Fetal Medicine 317.944.7010 procedure—to­ give him relief from worsening epileptic cerebral hemisphere, which caused hydrocephalus at a very high rate,” Dr. Raskin said. “We found over time that if you seizures he suffered for years. Neurosurgery 317.944.6201 leave brain tissue behind that’s disconnected, it seizes by It wasn’t an easy journey for Noah or his mom, Susan itself but it just takes up space and can’t signal any distress Ophthalmology 317.944.8103 Pahls, who lived in a state of near-constant anxiety for to the body.” years, first with the cancer, then with the seizures. After Orthopedic Surgery 317.948.2550 the malignant tumor was removed, Noah went through 33 For weeks after the surgery, Noah rehabbed at Riley before radiation treatments with resulting damage to his brain that being released amid cheers and well wishes from hospital Otolaryngology – Head & Neck Surgery 317.944.6467 contributed to severe seizures—as many as 300 to 400 a team members. Pediatric Surgery 317.274.4682 day—that threatened his life. “This is a really good illustration of how seizures have more Plastic Surgery 317.948.0345 Based on an operation performed last year by pediatric of an impact on quality of life than tumors sometimes,” Dr. Raskin said. “Noah’s original problem was a brain neurosurgeon Jeffrey S. Raskin, MD, those days are Transplant Surgery 317.944.4370 hopefully in the past for Noah. A functional hemispherotomy tumor, and it was an aggressive tumor. It’s because of the is a disconnection of one cerebral hemisphere from the tumor and treatment that he had the seizures and that was Urology 317.944.8896 body and the brain. Used to isolate abnormal brain activity really what was impacting his life. To remove or reduce the in one half of the brain to limit serious seizures, it offers seizures is the most meaningful thing we could do for him.”

“One of the steps of the procedure is to disconnect a very large cerebral artery; it’s as aggressive as any epilepsy surgery gets, and On the back cover we’re doing it here.” Soon after Amelia Beard was born, tests revealed she had Jeffrey S. Raskin, MD hypoplastic left heart syndrome. Flown via LifeLine to Riley, Amelia Pediatric neurosurgeon underwent successful open- heart surgery. Riley cardiac surgeons and team members cared for Amelia (pictured with her mom, Tara) during her three-month hospital stay. The Riley Heart Center, ranked fifth in the nation by U.S. News & World Report, is consistently recognized for achieving exceptional patient outcomes.

40 | Riley Children’s Health Surgery Annual Report 2019 | 41 Riley Children’s at Indiana University Health Riley Children’s Health is Indiana’s only full-service statewide pediatric health system. Riley Children’s Health offers complete, comprehensive pediatric care ranging from routine primary care checkups to the most complex acute care needs from highly skilled pediatric specialists. The system connects patients with 200 primary care and 400 specialty care physicians in communities across the state of Indiana. Riley Physicians treat patients in their home communities, bringing top-notch care close to home. This statewide network is an extension of Riley Hospital for Children at Indiana University Health, one of the nation’s leading children’s hospitals. rileychildrens.org ©2020 IUHealth 10/20 IUH#33340