Pull-through procedure in children with Hirschsprung disease: A nationwide analysis on postoperative outcomes

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Health Services Research

Background:

• Hirschsprung disease is a congenital condition requiring surgical intervention.
• Pull-through operations are the standard surgical treatment for Hirschsprung disease in children.
• Nationwide data on readmission rates and outcomes following pediatric Hirschsprung disease surgery are limited.

Purpose of the Study:

• To identify factors associated with postoperative outcomes and hospital readmissions in children undergoing pull-through operations for Hirschsprung disease.
• To analyze national trends in readmission for pediatric Hirschsprung disease patients.

Main Methods:

• Retrospective analysis of the Nationwide Readmissions Database (2010-2014).
• Inclusion of pediatric patients (<18 years) with Hirschsprung disease (ICD-9: 751.3) who underwent pull-through procedures (ICD-9: 48.40-69).
• Assessment of 30-day and 1-year readmission rates, complications, and associated costs.

Main Results:

• The study included 3635 pediatric patients, predominantly male (75%) and infants (<1 year, 79%).
• Readmission rates were 20% at 30 days and 36% at 1 year, with gastrointestinal disorders (46%) and infections (39%) as primary reasons.
• Infants faced higher readmissions for enterocolitis and infections, while older children experienced more electrolyte disturbances; total costs exceeded $162 million.

Conclusions:

• Pediatric pull-through surgery for Hirschsprung disease is linked to substantial readmission rates and significant economic burden.
• Targeted, age-specific interventions are crucial for preventing readmissions and optimizing patient outcomes.
• Reducing readmissions can lead to considerable savings in pediatric healthcare expenditure.