Social Determinants of Health Are Associated with Failed Bowel Management for Children with Anorectal Malformations
Shruthi Srinivas1, Maria E Knaus1, Drayson Campbell2
1Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, United States.
Insights
Social determinants of health significantly impact bowel management program (BMP) success in children with anorectal malformations (ARMs). Addressing factors like insurance and family support can improve outcomes for these patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Public Health
Background:
- Children with anorectal malformations (ARMs) often require bowel management programs (BMPs) for constipation and fecal incontinence.
- Understanding the influence of social determinants of health (SDOH) on BMP outcomes is crucial for this population.
Purpose of the Study:
- To investigate the association between SDOH and the success of BMPs in children with ARM.
- To identify specific social factors that predict BMP failure.
Main Methods:
- Retrospective review of 239 children with ARM who underwent BMP between 2014 and 2021.
- Data collected included clinical, surgical, and SDOH factors.
- Patients were classified as 'clean' or 'not clean' based on Rome IV criteria post-BMP.
Main Results:
- 34% of patients (81/239) were not clean after BMP.
- BMP failure was significantly associated with public insurance, proximity to the institution, parental marital status, extended family living situations, and lack of formal support systems.
- Prior antegrade enema use also correlated with higher failure rates.
Conclusions:
- Several SDOH are significantly correlated with BMP failure in children with ARM.
- Identifying patients with adverse SDOH may allow for targeted interventions to improve BMP outcomes.
Introduction:
Children with anorectal malformations (ARMs) benefit from bowel management programs (BMPs) to manage constipation or fecal incontinence. We aimed to understand the role of social determinants of health (SDOH) in outcomes following BMPs in this population.
Materials And Methods:
A single-institution, institutional review board (IRB) approved, retrospective review was performed in children with ARM who underwent BMP from 2014 to 2021. Clinical, surgical, and SDOH data were collected. Children were stratified as clean or not clean per the Rome IV criteria at the completion of BMP. Descriptive statistics were computed. Categorical variables were analyzed via Fisher's exact tests and continuous variables with Mood's median tests.
Results:
In total, 239 patients who underwent BMP were identified; their median age was 6.62 years (interquartile range [IQR]: 4.78-9.83). Of these, 81 (34%) were not clean after completing BMP. Children with prior history of antegrade enema procedures had a higher rate of failure. Children who held public insurance, lived within driving distance, had unmarried parents, lived with extended family, and lacked formal support systems had a significant association with BMP failure (p < 0.05 for all). Type of ARM, age at repair, type of repair, age at BMP, and type of BMP regimen were not significantly associated with failure.
Conclusions:
There is a significant correlation of failure of BMPs with several SDOH elements in patients with ARM. Attention to SDOH may help identify high-risk patients in whom additional care may lead improved outcomes following BMP.
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