Abstract
We aimed to analyze the effect of age and weight on 30-day outcomes of single-stage endorectal pull tthrough (ERPT) procedures for Hirschsprung's Disease (HD) using the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database to identify an optimal time for surgery. We queried NSQIP-P for children <2 years with HD who underwent ERPT between 2016-2021 and did not have a preoperative stoma. Patients were stratified by age (<3 months, 3-6 months and >6 months) and weight (<4kg, 4-8kg, and >8kg) at the time of surgery. The primary outcome measure was major adverse outcomes, and the secondary outcomes were 30-day unplanned readmission and reoperation. Multivariable logistic regression was conducted to analyze the association between age and weight and each outcome. A total of 1002 patients were included with a median age of 31 days (IQR: 10-106 days). Patients were stratified by age (n=702, 70.1%; n=158, 15.8%; n=142, 14.2% respectively from youngest to oldest) and weight (n=472, 47.1%; n=421, 42.0%; n=109, 10.9% respectively from lowest to highest weight) groups. On multivariable analysis, age>6 months and weight>8kg were independently associated with a higher rate of major complications (aOR=2.741, 95% C.I.=1.234-5.880 and aOR=4.627, 95% C.I.=1.761-11.775 respectively). Conversely, being in the highest age (aOR=0.359, 95% C.I.=0.176-0.699) and weight brackets (aOR=0.396, 95% C.I.=0.171-0.801) independently predicted lower 30-day readmission rates. Earlier single-stage ERPT for HD was found to be associated with lower complication rates in a select group of patients but may result in increased rates of readmissions and hospital resource utilization. Level III evidence. Retrospective cohort study.
Published Version
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