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Minimizing variance in pediatric patients after repair of anorectal malformations

Leigh Selesner1, Ryan Bigej2,3, Sara Alturky2

  • 1Depart of Surgery, Oregon Health & Science University, Portland, OR, USA. selesner@ohsu.edu.

Pediatric Surgery International
|May 29, 2025
PubMed

Insights

A new perioperative protocol for anorectal malformation (ARM) surgery was feasible across two hospitals, maintaining short lengths of stay (LOS) and few complications. Protocol compliance was moderate, with areas for improvement noted.

Area of Science:

  • Pediatric surgery
  • Surgical protocols
  • Anorectal malformations

Background:

  • Anorectal malformation (ARM) requires complex perioperative management.
  • Standardization of care can improve outcomes in pediatric surgical conditions.
  • Variability in perioperative care may impact patient outcomes and resource utilization.

Purpose of the Study:

  • To evaluate the feasibility and impact of a standardized perioperative protocol for anorectal malformation (ARM) surgery.
  • To assess complications, length of stay (LOS), and protocol compliance after implementation.
  • To compare outcomes between a protocol cohort and a historical control cohort.

Main Methods:

  • A standardized perioperative protocol for ARM was implemented across two pediatric tertiary hospitals.
  • Data from a 24-month protocol cohort were compared to a 24-month control cohort.
  • Outcomes assessed included demographics, compliance, complications, and length of stay (LOS).

Main Results:

  • Forty-five patients were included; 89% completed VACTERL workup.
  • Median postoperative LOS was 2 days in both control and protocol groups (p=0.80).
  • No significant difference in total LOS or wound infections was observed; wound dehiscence occurred in 3 patients.
  • Protocol compliance was 53%, with deviations in diet, VACTERL workup, and wound care.

Conclusions:

  • A standardized ARM perioperative protocol is feasible and can be implemented across institutions.
  • The protocol maintained excellent outcomes, including short LOS and minimal complications.
  • Further refinement is needed to improve protocol compliance, despite demonstrated feasibility and positive outcomes.
Abstract

Keywords:
Anorectal malformationPediatric surgeryPerioperative management protocolPosterior sagittal anorectoplastyQuality improvement

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