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Hirschsprung-associated enterocolitis in children treated at US children's hospitals
Liese C C Pruitt1, David E Skarda2, Michael D Rollins2
1University of Utah, Department of Surgery, Division of Pediatric Surgery, Salt Lake City, UT.
Insights
Hirschsprung's-associated enterocolitis (HAEC) affects 7% of infants after pull-through surgery, increasing reoperation risks. Further multicenter research is needed to develop prediction models and treatment protocols for HAEC.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Research
Background:
- Hirschsprung's-associated enterocolitis (HAEC) is a serious complication following pull-through surgery for Hirschsprung's Disease (HD).
- Previous studies on HAEC incidence and risk factors were limited to single institutions.
- This study aimed to characterize post-operative HAEC on a larger scale.
Purpose of the Study:
- To determine the incidence and risk factors of HAEC after pull-through surgery in infants with HD.
- To investigate the consequences of recurrent HAEC, specifically its association with reoperations.
- To provide data for the development of improved prediction models and treatment strategies for HAEC.
Main Methods:
- Retrospective cohort study of 2030 children with HD who underwent pull-through surgery before age 1, from 2007-2017.
- HAEC readmissions identified using ICD-9/10 codes and antibiotic administration.
- Hierarchical logistic regression used to identify risk factors for HAEC and its effect on reoperations.
Main Results:
- 7% (138/2030) of infants experienced two or more HAEC readmissions.
- Recurrent HAEC was associated with pre-operative HAEC, CNS infection history, and congenital neurologic anomalies.
- Recurrent HAEC significantly predicted HD-specific re-operation (OR 5.2) but not in-hospital mortality.
Conclusions:
- HAEC is a significant concern in infants with HD post-pull-through, occurring in a substantial proportion and predicting reoperation.
- Multicenter studies are essential for developing robust prediction models and standardized treatment protocols for HAEC.
- Early identification of risk factors and effective management of HAEC are crucial for improving outcomes in children with HD.
Background:
The incidence of and risk factors for Hirschsprung's-associated enterocolitis (HAEC) following pull-through have been limited to single institutions studies. We characterized the incidence of, risk factors for, and consequences of post-operative HAEC.
Methods:
We identified children with Hirschsprung's Disease (HD) at US Children's Hospitals from 2007 to 2017 with and an associated pull-through operation at less than 1 year of age. HAEC readmissions were identified using ICD9/10 Diagnosis Codes and antibiotic administration. Hierarchical logistic regression models were developed for the risk factors for HAEC after pull-through and effects of recurrent HAEC on HD-related reoperations.
Results:
We identified 2030 children with HD, and 138 (7%) who had two or more readmissions related to HAEC. The frequency of recurrent HAEC by hospital ranged from 0 to 33%. Pre-operative HAEC, history of central nervous system infection, and congenital neurologic anomalies were associated with increased risk of recurrent HAEC. Recurrent HAEC was associated with HD-specific re-operation (OR 5.2, CI 3.3-8.1, p < 0.001); however, it was not associated with risk of in-hospital mortality (OR 3.3, CI 0.88-12.1, p = 0.08).
Conclusions:
HAEC following pull-through occurs in a large proportion of infants with HD and predicts reoperation. Multicenter studies are needed to develop prediction models and treatment protocols for HAEC.
Level Of Evidence:
II TYPE OF STUDY: Retrospective cohort study.