Jason P Sulkowski1, Jennifer N Cooper1, Anthony Congeni1, Erik G Pearson2, Benedict C Nwomeh1, Edward J Doolin2, Martin L Blakely3, Peter C Minneci1, Katherine J Deans4. 1. Center for Surgical Outcomes Research and Department of Surgery, Nationwide Children's Hospital, Columbus, OH. 2. Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA. 3. Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital, Nashville, TN. 4. Center for Surgical Outcomes Research and Department of Surgery, Nationwide Children's Hospital, Columbus, OH. Electronic address: katherine.deans@nationwidechildrens.org.
Abstract
PURPOSE: The aim of this study was to evaluate surgical treatments and outcomes in a multi-institutional cohort of neonates with Hirschsprung's disease (HD). METHODS: Using the Pediatric Health Information System (PHIS) from 1999 to 2009, neonates diagnosed with HD were identified and classified as having a single stage pull-through (SSPT) or multi-stage pull-through (MSPT). Diagnosis and classification algorithms and clinical variables and outcomes were validated by multi-institutional chart review. Groups were compared using logistic regression modeling and propensity-score matched analysis to account for baseline differences between groups. RESULTS: 1555 neonates with HD were identified; 77.2% underwent SSPT and 22.8% underwent MSPT. Misclassification of disease or surgical treatment was <2%. Rates of SSPT increased over time (p=0.03). Compared to SSPT, patients undergoing MSPT had significantly lower birth weights and higher rates of prematurity, non-HD gastrointestinal anomalies, enterocolitis, and preoperative mechanical ventilation. Patients undergoing MSPT had significantly higher rates of readmissions (58.5 vs. 37.9%) and additional operations (38.7 vs. 26%). Results were consistent in the propensity-score matched analysis. CONCLUSION: Most neonates with HD undergo SSPT. In patients with similar observed baseline characteristics, MSPT was associated with worse outcomes suggesting that some infants currently selected to undergo MSPT may have better outcomes with SSPT. However, there remains a subgroup of MSPT patients who were too ill to be adequately compared to SSPT patients; for this subgroup of severely ill infants with HD, MSPT may be the best option.
PURPOSE: The aim of this study was to evaluate surgical treatments and outcomes in a multi-institutional cohort of neonates with Hirschsprung's disease (HD). METHODS: Using the Pediatric Health Information System (PHIS) from 1999 to 2009, neonates diagnosed with HD were identified and classified as having a single stage pull-through (SSPT) or multi-stage pull-through (MSPT). Diagnosis and classification algorithms and clinical variables and outcomes were validated by multi-institutional chart review. Groups were compared using logistic regression modeling and propensity-score matched analysis to account for baseline differences between groups. RESULTS: 1555 neonates with HD were identified; 77.2% underwent SSPT and 22.8% underwent MSPT. Misclassification of disease or surgical treatment was <2%. Rates of SSPT increased over time (p=0.03). Compared to SSPT, patients undergoing MSPT had significantly lower birth weights and higher rates of prematurity, non-HD gastrointestinal anomalies, enterocolitis, and preoperative mechanical ventilation. Patients undergoing MSPT had significantly higher rates of readmissions (58.5 vs. 37.9%) and additional operations (38.7 vs. 26%). Results were consistent in the propensity-score matched analysis. CONCLUSION: Most neonates with HD undergo SSPT. In patients with similar observed baseline characteristics, MSPT was associated with worse outcomes suggesting that some infants currently selected to undergo MSPT may have better outcomes with SSPT. However, there remains a subgroup of MSPTpatients who were too ill to be adequately compared to SSPTpatients; for this subgroup of severely ill infants with HD, MSPT may be the best option.
Authors: D H Teitelbaum; R E Cilley; N J Sherman; D Bliss; N D Uitvlugt; E J Renaud; I Kirstioglu; T Bengston; A G Coran Journal: Ann Surg Date: 2000-09 Impact factor: 12.969
Authors: David Fox; Elaine Morrato; Elizabeth J Campagna; Daniel I Rees; L Miriam Dickinson; David A Partrick; Allison Kempe Journal: Pediatrics Date: 2011-04-18 Impact factor: 7.124
Authors: Laurens D Eeftinck Schattenkerk; Gijsbert D Musters; David J Nijssen; Wouter J de Jonge; Ralph de Vries; L W Ernest van Heurn; Joep P M Derikx Journal: Innov Surg Sci Date: 2021-08-17
Authors: Christopher R Schlieve; Kathryn L Fowler; Matthew Thornton; Sha Huang; Ibrahim Hajjali; Xiaogang Hou; Brendan Grubbs; Jason R Spence; Tracy C Grikscheit Journal: Stem Cell Reports Date: 2017-08-10 Impact factor: 7.765
Authors: Maggie L Westfal; Ongoly Okiemy; Patrick Ho Yu Chung; Jiexiong Feng; Changgui Lu; Go Miyano; Paul Kwong Hang Tam; Weibing Tang; Kenneth Kak Yuen Wong; Atsuyuki Yamataka; Richard A Guyer; Daniel P Doody; Allan M Goldstein Journal: J Pediatr Surg Date: 2021-07-21 Impact factor: 2.545