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Published on: September 20, 2018
Child Opportunity Index is Not Associated With Cleanliness in Patients With Anorectal Malformations Treated at
Shruthi Srinivas1, Caitlin A Smith2, Kelly Austin3
1Department of Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
Insights
Child Opportunity Index (COI) did not correlate with bowel management or fecal cleanliness in children with anorectal malformations (ARMs). However, complications from antegrade continence enema (ACE) were higher in low-opportunity areas.
Area of Science:
- Pediatric Surgery
- Social Determinants of Health
- Colorectal Surgery
Background:
- Social determinants of health (SDOH) impact pediatric anorectal malformations (ARMs) outcomes.
- The Child Opportunity Index (COI) is a measure of neighborhood opportunity.
- Previous studies linked individual SDOH to negative ARM outcomes.
Purpose of the Study:
- To investigate the association between the Child Opportunity Index (COI) and bowel management strategy in pediatric ARM patients.
- To assess the relationship between COI and fecal cleanliness in ARM patients.
- To determine if neighborhood opportunity influences treatment outcomes in ARM.
Main Methods:
- Retrospective review of 550 pediatric patients (≥4 years) with ARM from the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC).
- Exposure: Child Opportunity Index (COI) based on ZIP code.
- Outcomes: Fecal cleanliness (≤1 stool accident/week) and bowel management strategy. Antegrade continence enema (ACE) complications were also analyzed.
Main Results:
- No significant differences in fecal cleanliness or bowel management strategy were found across different COI levels.
- Most patients (75.1%) resided in moderate to very high opportunity areas.
- Complications from ACE placement were more frequent in children from low-opportunity areas (22.2%) compared to higher opportunity areas (2.9%).
Conclusions:
- Child Opportunity Index (COI) is not associated with bowel management strategy or fecal cleanliness in ARM patients treated at specialized centers.
- Individual disparities, rather than neighborhood-level opportunity, may be more critical for understanding outcomes in ARM.
- Further research is needed to explore individual-level social determinants impacting ARM patient management.
Background:
Individually collected social determinants of health (SDOH) have been associated with negative outcomes in children with anorectal malformations (ARMs). Our aim was to assess whether the Child Opportunity Index (COI) is associated with bowel management strategy and fecal cleanliness in patients with ARM managed at specialized pediatric colorectal centers. We hypothesized that children from low COI would have lower rates of cleanliness.
Methods:
A multi-institutional retrospective review evaluated children ≥4 years old with ARM treated at centers participating in the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC), excluding patients with ostomies. The primary exposure was COI, obtained by ZIP code. The primary outcome was fecal cleanliness, defined as ≤1 weekly stool accident. Additional variables evaluated included demographics, ARM severity, bowel management type, medical comorbidities, and complications in those undergoing antegrade continence enema procedures. COI groups were compared for trend (p-value ≤0.05 as significant).
Results:
The cohort included 550 patients, most (75.1%) residing in moderate, high, or very high opportunity areas. There were no differences in ARM severity between COI groups. Stratified by age, there were no differences in fecal cleanliness (p = 0.788) or bowel management strategy (p = 0.224) by COI. There were few overall complications from ACE placement (12.3%), but ACE complications were more common in children from low-opportunity areas (22.2% vs 2.9%; p = 0.01).
Conclusion:
Contrary to hypothesized, children with anorectal malformations managed at tertiary institutions within PCPLC do not differ by COI in bowel management strategy or fecal cleanliness outcome. Further investigation into individual disparities may be more important in these patients.
Level Of Evidence:
III = retrospective comparative study.
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