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  1. Article ; Online: Is the writing on the wall? The relationship between the number of disease-modifying anti-inflammatory bowel disease drugs used and the risk of surgical resection.

    Mankarious, Marc M / Greene, Alicia C / Schaefer, Eric W / Clarke, Kofi / Kulaylat, Afif N / Jeganathan, Nimalan A / Deutsch, Michael J / Kulaylat, Audrey S

    Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract

    2024  

    Abstract: Background: Disease-modifying anti-inflammatory bowel disease drugs (DMAIDs) revolutionized the management of ulcerative colitis (UC). This study assessed the relationship between the number and timing of drugs used to treat UC and the risk of colectomy ...

    Abstract Background: Disease-modifying anti-inflammatory bowel disease drugs (DMAIDs) revolutionized the management of ulcerative colitis (UC). This study assessed the relationship between the number and timing of drugs used to treat UC and the risk of colectomy and postoperative complications.
    Methods: This was a retrospective review of adult patients with UC treated with disease-modifying drugs between 2005 and 2020 in the MarketScan database. Landmark and time-varying regression analyses were used to analyze risk of surgical resection. Multivariable Cox regression analysis was used to determine risk of postoperative complications, emergency room visits, and readmissions.
    Results: A total of 12,193 patients with UC and treated with disease-modifying drugs were identified. With a median follow-up time of 1.7 years, 23.8% used >1 drug, and 8.3% of patients required surgical resection. In landmark analyses, using 2 and ≥3 drugs before the landmark date was associated with higher incidence of surgery for each landmark than 1 drug. Multivariable Cox regression showed hazard ratio (95% CIs) of 4.22 (3.59-4.97), 11.7 (9.01-15.3), and 22.9 (15.0-34.9) for using 2, 3, and ≥4 drugs, respectively, compared with using 1 DMAID. That risk was constant overtime. The number of drugs used preoperatively was not associated with an increased postoperative risk of any complication, emergency room visits, or readmission.
    Conclusion: The use of multiple disease-modifying drugs in UC is associated with an increased risk of surgical resection with each additional drug. This provides important prognostic data and highlights the importance of patient counseling with minimal concern regarding risk of postoperative morbidity for additional drugs.
    Language English
    Publishing date 2024-03-13
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 2012365-6
    ISSN 1873-4626 ; 1934-3213 ; 1091-255X
    ISSN (online) 1873-4626 ; 1934-3213
    ISSN 1091-255X
    DOI 10.1016/j.gassur.2024.03.011
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    Zs.A 5207: Show issues Location:
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  2. Article ; Online: Evaluating the Implementation of a Medical Student's Handoff Curriculum During the Surgery Clerkship.

    Kulaylat, Afif N / Saunders, Brian D / Allen, Steven R / Aarons, Cary B / Hoffman, Rebecca L

    The Journal of surgical research

    2022  Volume 282, Page(s) 262–269

    Abstract: Introduction: Early introduction to essential communication skills is important. We sought to determine if a handoff curriculum (HC) would improve confidence, decrease anxiety, and increase participation in clinical handoffs during the surgical ... ...

    Abstract Introduction: Early introduction to essential communication skills is important. We sought to determine if a handoff curriculum (HC) would improve confidence, decrease anxiety, and increase participation in clinical handoffs during the surgical clerkship.
    Methods: A multi-center prospective cohort study was performed at two medical schools. Training in the intervention group (HC) consisted of a didactic lecture, video review, and practice session. Students completed a pre-clerkship knowledge test and confidence/anxiety/handoff experience questionnaire pre- and post-clerkship.
    Results: There were no significant differences in pre-clerkship handoff experiences between institutions except having previously witnessed a verbal handoff (School A 96.4% versus School B 76.2%, P = 0.01). While there were no significant differences in post-clerkship confidence or anxiety, HC students were significantly more involved with written sign-outs (52.9% versus 18.2%, P = 0.02) and verbal handoffs (29.4% versus 4.6%, P = 0.03).
    Conclusions: Medical students exposed to handoff training shared similar confidence and anxiety scores compared to those that were not, however, they were more involved in handoff experiences during their surgical clerkship. Early introduction to handoff skills may encourage greater participation during subsequent clinical experiences.
    MeSH term(s) Humans ; Clinical Clerkship ; Students, Medical ; Patient Handoff ; Prospective Studies ; Curriculum
    Language English
    Publishing date 2022-11-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80170-7
    ISSN 1095-8673 ; 0022-4804
    ISSN (online) 1095-8673
    ISSN 0022-4804
    DOI 10.1016/j.jss.2022.10.005
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  3. Article ; Online: Increasing Adoption of Laparoscopy in Urgent and Emergent Colectomies for Pediatric Ulcerative Colitis.

    Greene, Alicia C / Mankarious, Marc M / Finkelstein, Adam / El-Mallah, Jessica C / Kulaylat, Audrey S / Kulaylat, Afif N

    The Journal of surgical research

    2023  Volume 295, Page(s) 399–406

    Abstract: Introduction: While minimally invasive surgery (MIS) approaches are commonly utilized in the elective surgical setting for pediatric ulcerative colitis (UC), their role in urgent and emergent disease is less clear. We aim to assess trends in the ... ...

    Abstract Introduction: While minimally invasive surgery (MIS) approaches are commonly utilized in the elective surgical setting for pediatric ulcerative colitis (UC), their role in urgent and emergent disease is less clear. We aim to assess trends in the surgical approaches for pediatric UC patients requiring urgent and emergent colectomies and their associated outcomes.
    Methods: Retrospective review of 81 pediatric UC patients identified in National Surgical Quality Improvement Program Pediatric who underwent urgent or emergent colectomy (2012-2019). Trends in approach were assessed using linear regression. Patient characteristics and clinical outcomes were stratified by approach and compared using standard univariate statistics. Multivariable analysis was used to model the influence of covariates on postoperative length of stay.
    Results: The proportion of MIS cases increased by 5.53% per year (P = 0.01) over the study interval. Sixty-three patients (77.8%) received MIS resections and 18 patients (22.2%) received open resections. Patients undergoing open colectomies were younger and had a higher proportion of preoperative conditions, most notably preoperative sepsis (27.8% versus 4.8%, P = 0.01), and higher American Society of Anesthesiologists [III-IV] classification (83.3% versus 58.8%, P = 0.004). Mean operative time was comparable (open, 173.6 versus MIS, 206.1 min). In the univariate analysis, open approach was associated with increased postoperative length of stay (13.1 versus 7.2 d, P = 0.002). However, after adjusting for confounders, there was no significant difference.
    Conclusions: There has been a steady increase in the adoption of laparoscopy in urgent and emergent colectomy for pediatric UC. Short-term outcomes between approaches appear comparable.
    MeSH term(s) Humans ; Child ; Colitis, Ulcerative/surgery ; Colectomy/adverse effects ; Retrospective Studies ; Laparoscopy/adverse effects ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/surgery
    Language English
    Publishing date 2023-12-08
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80170-7
    ISSN 1095-8673 ; 0022-4804
    ISSN (online) 1095-8673
    ISSN 0022-4804
    DOI 10.1016/j.jss.2023.11.007
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    Zs.A 178: Show issues Location:
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  4. Article ; Online: Reducing Postoperative CT Imaging for Children With Complicated Appendicitis: A Pediatric Surgical Quality Collaborative Quality Improvement Project.

    Juviler, Peter / Greene, Alicia C / Fisher, Terry / Kulaylat, Afif N / Chandler, John / Gray, Fabienne / Gingalewski, Cindy / Ehster, Catherine / Bolhuis, Mary / Garcia, Elisa / Broussard, Maryam / Lally, Kevin P / Levene, Tamar / Wakeman, Derek

    Journal of pediatric surgery

    2024  

    Abstract: Background: Despite widespread initiatives to reduce ionizing radiation for appendicitis diagnosis, computed tomography (CT) scanning postoperatively remains common. The Pediatric Surgery Quality Collaborative (PSQC) aimed to identify differences ... ...

    Abstract Background: Despite widespread initiatives to reduce ionizing radiation for appendicitis diagnosis, computed tomography (CT) scanning postoperatively remains common. The Pediatric Surgery Quality Collaborative (PSQC) aimed to identify differences between children's hospitals with high and low postoperative CT usage for complicated appendicitis.
    Methods: Using National Surgery Quality Improvement Program Pediatric data from PSQC children's hospitals, we compared postoperative CT imaging for complicated appendicitis (April 2020-March 2021). Key stakeholders from 11 hospitals (5 low CT utilization, 6 high CT utilization) participated in semi-structured interviews regarding postoperative imaging. Qualitative analysis of transcripts was performed deductively and inductively based on the Theoretical Domains Framework (TDF).
    Results: Five of twelve TDF domains were most prominent in influencing CT use: skills, beliefs about capabilities, intentions/goals, memory and decision processes, and environment. Children's hospitals with lower rates of postoperative CT use tended to: trust and educate the ultrasound technicians; believe US strengths outweigh weaknesses; image no sooner than 7 days postoperatively; have access to sufficient quality improvement resources; maintain trusting relationships between specialties; and prioritize radiation stewardship.
    Conclusion: Hospitals at extremes of postoperative CT use for complicated appendicitis reveal strategies for improvement, which include imaging protocol development and adherence, quality improvement resource availability, interdisciplinary collaboration, and promoting radiation stewardship.
    Level of evidence: Level V.
    Language English
    Publishing date 2024-03-20
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80165-3
    ISSN 1531-5037 ; 0022-3468
    ISSN (online) 1531-5037
    ISSN 0022-3468
    DOI 10.1016/j.jpedsurg.2024.03.040
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    Zs.A 607: Show issues Location:
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  5. Article ; Online: Development of a Standardized Program for the Collaboration of Adult and Children's Surgeons.

    DeLong, Colin G / McLaughlin, Christopher J / Kulaylat, Afif N / Cilley, Robert E

    The Journal of surgical research

    2021  Volume 269, Page(s) 36–43

    Abstract: Background: Children's hospitals within larger hospitals (CH/LH) have the specific clinical advantage of easily facilitated collaboration between adult and children's surgeons. These collaborations, which we have termed hybrid surgical offerings (HSOs) ... ...

    Abstract Background: Children's hospitals within larger hospitals (CH/LH) have the specific clinical advantage of easily facilitated collaboration between adult and children's surgeons. These collaborations, which we have termed hybrid surgical offerings (HSOs) are often required for disease processes requiring interventions that fall outside the customary practice of children's surgeons. Formal models to describe or evaluate these practices are lacking.
    Methods: HSOs within a CH/LH were identified. Principles of systems-engineering were used to develop a standardized model (Children's Hybrid Enhanced Surgical Services [CHESS]) to describe and evaluate HSOs. Face validity was established via unstructured interviews of CH leaders and HSO surgeons. Areas for improved system-wide standardization and programmatic development were identified.
    Results: HSOs were identified in collaboration with adult bariatric, minimally invasive, advanced endoscopic, endocrine, thoracic, and orthopedic trauma surgical services. The CHESS framework encompassed: 1) quality improvement metrics, 2) credentialing and oversight, 3) transitions of care, 4) pediatric family-centered care, 5) maintenance of the cycle of expertise, 6) continuing medical education, 7) scholarship. While HSOs fulfilled the majority of aforementioned programmatic domains across all six HSO-providing services, areas for improvement included maintaining a cycle of expertise (33%), quality improvement metrics (50%), and pediatric family-centered care (66%).  Additional noted advantages included faster translation of adult innovation to pediatric care and facilitation of emergency interdisciplinary care.
    Conclusion: Formal evaluation of HSOs is necessary to standardize and improve the quality of children's surgical care. Development of a structured framework such as CHESS addresses gaps in quality oversight and provides a basis for performance improvement, patient safety, and programmatic development.
    MeSH term(s) Adult ; Child ; Hospitals, Pediatric ; Humans ; Quality Improvement ; Specialties, Surgical ; Surgeons
    Language English
    Publishing date 2021-09-10
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80170-7
    ISSN 1095-8673 ; 0022-4804
    ISSN (online) 1095-8673
    ISSN 0022-4804
    DOI 10.1016/j.jss.2021.07.038
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    Zs.A 178: Show issues Location:
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  6. Article ; Online: The Association of Race, Sex, and Insurance With Transfer From Adult to Pediatric Trauma Centers.

    Kulaylat, Afif N / Hollenbeak, Christopher S / Armen, Scott B / Cilley, Robert E / Engbrecht, Brett W

    Pediatric emergency care

    2020  Volume 37, Issue 12, Page(s) e1623–e1630

    Abstract: Objective: Our objective was to investigate whether racial/ethnic-based or payer-based disparities existed in the transfer practices of pediatric trauma patients from adult trauma center (ATC) to pediatric trauma center (PTC) in Pennsylvania.: Methods! ...

    Abstract Objective: Our objective was to investigate whether racial/ethnic-based or payer-based disparities existed in the transfer practices of pediatric trauma patients from adult trauma center (ATC) to pediatric trauma center (PTC) in Pennsylvania.
    Methods: Data on trauma patients aged 14 years or less initially evaluated at level I and II ATC were obtained from the Pennsylvania Trauma Outcome Study (2008-2012) (n = 3446). Generalized estimating equations regression analyses were used to evaluate predictors of subsequent transfer controlling for confounders and clustering. Recent literature has described racial and socioeconomic disparities in outcomes such as mortality after trauma; it is unknown whether these factors also influence the likelihood of subsequent interfacility transfer between ATC and PTC.
    Results: Patients identified as nonwhite comprised 36.1% of the study population. Those without insurance comprised 9.9% of the population. There were 2790 patients (77.4%) who were subsequently transferred. Nonwhite race (odds ratio [OR], 4.3), female sex (OR, 1.3), and lack of insurance (OR, 2.3) were associated with interfacility transfer. Additional factors were identified influencing likelihood of transfer (increased odds: younger age, intubated status, cranial, orthopedic, and solid organ injury; decreased odds: operative intervention at the initial trauma center) (P < 0.05 for all).
    Conclusions: Although we assume that a desire for specialized care is the primary reason for transfer of injured children to PTCs, our analysis demonstrates that race, female sex, and lack of insurance are also associated with transfers from ATCs to PTCs for children younger than 15 years in Pennsylvania. Further research is needed to understand the basis of these health care disparities and their impact.
    MeSH term(s) Adult ; Child ; Female ; Humans ; Injury Severity Score ; Insurance ; Odds Ratio ; Outcome Assessment, Health Care ; Patient Transfer ; Retrospective Studies ; Trauma Centers ; Wounds and Injuries/epidemiology ; Wounds and Injuries/therapy
    Language English
    Publishing date 2020-06-16
    Publishing country United States
    Document type Journal Article
    ZDB-ID 632588-9
    ISSN 1535-1815 ; 0749-5161
    ISSN (online) 1535-1815
    ISSN 0749-5161
    DOI 10.1097/PEC.0000000000002137
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    Zs.A 2083: Show issues Location:
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  7. Article ; Online: A comparison of robotic-assisted splenectomy and laparoscopic splenectomy for children with hematologic disorders.

    Shelby, Rita / Kulaylat, Afif N / Villella, Anthony / Michalsky, Marc P / Diefenbach, Karen A / Aldrink, Jennifer H

    Journal of pediatric surgery

    2020  Volume 56, Issue 5, Page(s) 1047–1050

    Abstract: Introduction: Laparoscopic splenectomy (LS) is the standard of care for hematologic disorders requiring splenectomy. Less is known about the outcomes following robotic-assisted splenectomy (RS) for this indication. Our aim was to describe outcomes of RS ...

    Abstract Introduction: Laparoscopic splenectomy (LS) is the standard of care for hematologic disorders requiring splenectomy. Less is known about the outcomes following robotic-assisted splenectomy (RS) for this indication. Our aim was to describe outcomes of RS to LS in pediatric patients with hematologic disorders in our institution.
    Methods: A single institution retrospective review was performed of pediatric patients undergoing LS vs. RS from 2014 to 2019. Patient demographics, diagnosis, spleen size, hospital length of stay (LOS), operative time, post-operative opioid use, and hospital charges were evaluated. Standard univariate analyses were performed.
    Results: Twenty-four patients were included in the study (14 LS, 10 RS). The mean spleen size at the time of surgery was larger in the RS group compared to LS (14.5 cm vs. 12.2 cm, p = 0.03). Operative time between the two cohorts was comparable (RS 140.5 vs LS 154.9 min). Median LOS for RS was shorter than LS (2.1 vs. 3.2 days, p = 0.02). Cumulative postoperative opioid analgesic requirements were not significantly different between the groups (17.4 mg vs. 30.5 mg). The median hospital charges, including the surgical procedure and hospital stay were higher in the RS group ($44,724 RS vs $30,255 LS, p = 0.01).
    Conclusion: Robotic splenectomy is a safe and feasible option for pediatric patients with hematologic disorders, and was associated with decreased LOS but higher charges compared to laparoscopic splenectomy. Further studies are required to delineate the optimal use and potential benefits of robot-assisted surgical techniques in children.
    Level of evidence: II.
    MeSH term(s) Child ; Humans ; Laparoscopy ; Length of Stay ; Retrospective Studies ; Robotic Surgical Procedures ; Splenectomy ; Treatment Outcome
    Keywords covid19
    Language English
    Publishing date 2020-09-08
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80165-3
    ISSN 1531-5037 ; 0022-3468
    ISSN (online) 1531-5037
    ISSN 0022-3468
    DOI 10.1016/j.jpedsurg.2020.08.031
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    Zs.A 607: Show issues Location:
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  8. Article ; Online: Can magnetic resonance imaging replace computed tomography scans in the evaluation of pediatric post-appendectomy abscess?

    Greene, Alicia C / Mankarious, Marc M / Patel, Akshilkumar / Matzelle-Zywicki, Madeline / Kwon, Eustina G / Reyes, Lilia / Tsai, Anthony Y / Santos, Mary C / Moore, Michael M / Kulaylat, Afif N

    Surgery

    2023  Volume 174, Issue 3, Page(s) 703–708

    Abstract: Background: Computed tomography scans have been used when cross-axial imaging is required to evaluate pediatric post-appendectomy abscesses. To reduce a source of radiation exposure, our institution converted to using contrast-enhanced magnetic ... ...

    Abstract Background: Computed tomography scans have been used when cross-axial imaging is required to evaluate pediatric post-appendectomy abscesses. To reduce a source of radiation exposure, our institution converted to using contrast-enhanced magnetic resonance imaging to replace computed tomography scans in this clinical context. Our aim is to evaluate the performance of magnetic resonance imaging compared to computed tomography scans and associated clinical outcomes in this patient population.
    Methods: A contrast-enhanced comprehensive magnetic resonance imaging protocol was implemented to evaluate a post-appendectomy abscess in 2018. A retrospective chart review was performed from 2015 to 2022 for pediatric patients (<18 years old) with prior appendectomy and subsequent cross-sectional imaging to evaluate for an intraabdominal abscess. Patient characteristics and clinical parameters between the 2 modalities were abstracted and compared using standard univariate statistics.
    Results: There were a total of 72 post-appendectomy patients who received cross-axial imaging, which included 43 computed tomography scans and 29 magnetic resonance imaging during the study interval. Patient demographics were comparable between cohorts and rates of perforated appendicitis at the index operation (computed tomography: 79.1% vs magnetic resonance imaging: 86.2%). Missed abscess rate, abscess size, management technique, drainage culture results, readmission, and reoperation were similar between imaging modalities. Median request to scan time was longer for magnetic resonance imaging than computed tomography (191.5 vs 108 minutes, P = .04). The median duration of a comprehensive magnetic resonance imaging scan was 32 minutes (interquartile range 28-50.5 minutes).
    Conclusion: Contrast-enhanced magnetic resonance imaging provides an alternative cross-sectional imaging modality to computed tomography scans to evaluate pediatric post-appendectomy abscesses.
    MeSH term(s) Humans ; Child ; Adolescent ; Abscess/etiology ; Abscess/complications ; Retrospective Studies ; Appendectomy/adverse effects ; Appendectomy/methods ; Abdominal Abscess/diagnostic imaging ; Abdominal Abscess/etiology ; Magnetic Resonance Imaging/methods ; Appendicitis/diagnostic imaging ; Appendicitis/surgery ; Appendicitis/complications
    Language English
    Publishing date 2023-06-24
    Publishing country United States
    Document type Journal Article
    ZDB-ID 202467-6
    ISSN 1532-7361 ; 0039-6060
    ISSN (online) 1532-7361
    ISSN 0039-6060
    DOI 10.1016/j.surg.2023.05.018
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  9. Article ; Online: A Magnetic Resonance Imaging Protocol for the Evaluation of Pediatric Postappendectomy Abscess: A Quality Improvement Project.

    Greene, Alicia C / Mankarious, Marc M / Matzelle-Zywicki, Madeline / Patel, Akshilkumar / Reyes, Lilia / Tsai, Anthony Y / Santos, Mary C / Moore, Michael M / Kulaylat, Afif N

    The Journal of surgical research

    2023  Volume 293, Page(s) 587–595

    Abstract: Introduction: Computed tomography (CT) scans are often used when cross-sectional imaging is required for evaluation of postappendectomy abscess, exposing children to a source of ionizing radiation. Our aim was to decrease the use of CT scans in ... ...

    Abstract Introduction: Computed tomography (CT) scans are often used when cross-sectional imaging is required for evaluation of postappendectomy abscess, exposing children to a source of ionizing radiation. Our aim was to decrease the use of CT scans in pediatric postappendectomy patients by 50% in 12 mo and to sustain those results for 1 y.
    Methods: A comprehensive magnetic resonance imaging protocol was introduced in 2018 at a tertiary children's hospital within a general health system to replace CT scans in suspected pediatric postappendectomy abscess. Diagnostic and clinical outcomes were compared preprotocol (2015-2017) and postprotocol (2018-2022) implementation using standard univariate statistics. P < 0.05 was considered significant. Quality improvement methodology was used to design and implement the protocol.
    Results: Sixty eight pediatric postappendectomy patients received cross-sectional imaging during the study period. Overall, CT scans were used exclusively (100%, n = 27) in the preimplementation period compared to 31.7% (n = 13) of cross-sectional imaging in the postimplementation period. However, in the first year of protocol implementation, CT scan use only decreased to 78% of cross-sectional studies performed. The majority of protocol deviations (54%) also occurred in this time period. With improved education and reinforcement, CT scan utilization decreased to approximately 24% of cross-sectional studies annually. Missed abscess rate, time to diagnosis, drainage procedure type, readmission, and reoperation were similar between preimplementation and postimplementation periods.
    Conclusions: Implementation of a postappendectomy abscess magnetic resonance imaging protocol was associated with decreased CT utilization in the pediatric population, while maintaining comparable diagnostic evaluation and clinical outcomes. Adherence to quality improvement principles facilitated achieving goals and sustaining gains.
    MeSH term(s) Child ; Humans ; Quality Improvement ; Abscess ; Retrospective Studies ; Magnetic Resonance Imaging ; Appendectomy/adverse effects ; Appendicitis/surgery
    Language English
    Publishing date 2023-10-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80170-7
    ISSN 1095-8673 ; 0022-4804
    ISSN (online) 1095-8673
    ISSN 0022-4804
    DOI 10.1016/j.jss.2023.09.029
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  10. Article ; Online: Primary Posterior Sagittal Anorectoplasty Outcomes for Rectovestibular and Perineal Fistulas Using an Accelerated Pathway: a Single Institution Study.

    Rocourt, Dorothy V / Kulaylat, Audrey S / Kulaylat, Afif N / Leung, Stephan / Cilley, Robert E

    Journal of pediatric surgery

    2019  Volume 54, Issue 9, Page(s) 1778–1781

    Abstract: Background: Posterior sagittal anorectoplasty (PSARP) is the most common surgical treatment for patients with anorectal malformations. Such patients are often subjected to prolonged nil per os (NPO), antibiotic use, and use of parenteral nutrition. Our ... ...

    Abstract Background: Posterior sagittal anorectoplasty (PSARP) is the most common surgical treatment for patients with anorectal malformations. Such patients are often subjected to prolonged nil per os (NPO), antibiotic use, and use of parenteral nutrition. Our aim was to review our institutional experience with patients undergoing PSARP using an accelerated standardized postoperative pathway.
    Methods: Our hospital database was queried from 2004 to 2016 for patients diagnosed with imperforate anus who underwent a surgical procedure. Short term outcomes, hospital length of stay (LOS), and cost were evaluated.
    Results: Sixty-three patients were identified during the study period. Of these patients, 34 (54.0%) had a fistula to the urogenital tract or had no demonstrable fistula and one cloaca and 29 (46.0%) had a fistula in the perineum. Approximately half of patients underwent primary PSARP, including 8 patients with fistulas located in the vestibule and vagina in girls and two with no apparent fistulas (12.7% of total cohort). Only two postoperative complications occurred: one superficial surgical site infection and one perineal wound dehiscence. Among the whole cohort, median LOS was 3 days. Median time to PO intake was 2 days, and median cost was $11,532. No complications occurred among the subset of 8 patients undergoing primary PSARP.
    Conclusion: Patients undergoing PSARP experienced similar outcomes compared to historical series, suggesting that the accelerated pathway for early refeeding and reduced use of antibiotics may be beneficial in appropriately selected patients.
    Type of study: Case series with no comparison group Level of evidence Level IV.
    MeSH term(s) Anal Canal/surgery ; Anus, Imperforate/surgery ; Female ; Fistula/surgery ; Humans ; Infant ; Infant, Newborn ; Male ; Perineum/surgery ; Reconstructive Surgical Procedures/methods ; Rectum/surgery ; Retrospective Studies ; Treatment Outcome
    Language English
    Publishing date 2019-06-06
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80165-3
    ISSN 1531-5037 ; 0022-3468
    ISSN (online) 1531-5037
    ISSN 0022-3468
    DOI 10.1016/j.jpedsurg.2019.05.020
    Database MEDical Literature Analysis and Retrieval System OnLINE

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