Mytien Nguyen, Hyacinth R C Mason, Regina Russell, Tonya Fancher, Sarwat I Chaudhry, Mayur M Desai, Dowin Boatright
Leave of Absence and Medical Student Placement Into Graduate Medical Education by Race and Ethnicity
JAMA
background posterior sagittal anorectoplasty psarp standard management children high anorectal malformations arms recently increase use laparoscopy management analyzed outcomes laparoscopically assisted anorectal pullthrough laarp compared psarp using large inpatient database methods kids inpatient database analyzed arm icd9cm 7512 1997 2012 perineal fistulas lowintermediate arm excluded propensity score psmatched analyses performed using 37 variables cases weighted provide national estimates results overall 29106 cases 7428 patients 2 years underwent surgical repair laarp performed 178 patients eightyeight percent male caucasian n 71 45 followed hispanic n 41 26 descent performed 2009 2012 n 149 83 covered medicaid 88 49 followed private insurance 80 45 median length stay los 4 interquartile range 3 days majority performed childrens hospital n 90 88 psmatched analysis laarp shorter median los 4 3 compared psarp 6 15 days p 003 rates reoperation wound infection wound dehiscence mortality unchanged approaches cost lower laarp 47969 49450 versus psarp 56110 160314 us dollar p 002 whereas total charges differ significantly conclusions minimal access approach complex procedure requires significant time resources adopted standard psarp important example increased availability laparoscopy therefore access procedure patients greatly affect resource utilization recovery patient demonstrated los cost significantly lower laarp procedure comparison traditional approach future research clarify boundaries introducing laparoscopic approach potential standard technique next decade