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Prematurity Associated With Increased Complications and Reoperation After Pull-Through in Hirschsprung Disease
Elio R Bitar1, Mahmoud G El Baassiri2, Charbel Chidiac2
1Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
Insights
Premature birth increases complications and reoperations after Hirschsprung disease surgery. Healthcare providers should consider prematurity when managing postoperative care for these pediatric patients.
Area of Science:
- Pediatric Surgery
- Neonatal Medicine
- Gastroenterology
Background:
- Hirschsprung disease (HD) is a congenital condition affecting the enteric nervous system, necessitating surgical correction via pull-through procedures.
- Prematurity is a known risk factor for increased postoperative complications in pediatric surgery, but its specific impact on HD patients remains under investigation.
Purpose of the Study:
- To investigate the association between prematurity and short-term surgical outcomes, specifically 30-day postoperative complications and reoperation rates, in patients undergoing pull-through surgery for Hirschsprung disease.
Main Methods:
- A retrospective cohort study using the National Surgical Quality Improvement Program-Pediatric database (2016-2022).
- Patients aged 0-18 years undergoing pull-through surgery for HD were categorized as preterm (<37 weeks gestation) or full-term (≥37 weeks gestation).
- Logistic regression models were employed to assess the impact of prematurity on complication and reoperation rates.
Main Results:
- The study included 2603 HD patients, with 296 (11.4%) born preterm.
- Premature infants exhibited significantly higher rates of overall complications (24.3% vs. 16.7%) and reoperations related to the initial surgery (10.5% vs. 7.0%) within 30 days post-procedure.
- Multivariate analysis confirmed prematurity as an independent predictor of complications and reoperations in children under one year of age.
Conclusions:
- Premature birth is significantly associated with an increased risk of postoperative complications and reoperations following pull-through surgery for Hirschsprung disease.
- These findings underscore the importance of considering prematurity in the postoperative management and risk stratification of pediatric HD patients.
Introduction:
Hirschsprung disease (HD) is a congenital disorder of the enteric nervous system, requiring definitive surgical treatment through pull-through procedures. While prematurity generally increases postoperative risk, it remains unclear whether prematurity is associated with worse short-term surgical outcomes in HD patients. This study investigates the association between prematurity and postoperative complications and reoperation rates following pull-through procedures in HD.
Methods:
This retrospective cohort study utilized the National Surgical Quality Improvement Program-Pediatric database, identifying HD patients aged 0-18 ys who underwent pull-through surgery from 2016 to 2022. Patients were divided into two groups: preterm (born <37 wk gestation) and full-term (born ≥37 wk gestation). Outcomes of interest included 30-d postoperative complication rates and related reoperations. Univariate and multivariate logistic regression models assessed the association of prematurity with outcomes.
Results:
2603 patients were included, with 296 (11.4%) born preterm. 76.5% were males, and median age at surgery was 4 mos (interquartile range: 0.7-13.6). Overall, the rate of developing any complication was 17.6%. 9.1% of patients had an unplanned reoperation, including 7.4% related to the initial surgery. Premature infants had higher rates of developing any complication (24.3% versus 16.7%; P = 0.001) and related reoperations (10.5% versus 7.0%; P = 0.030) within 30 ds of undergoing pull-through surgery. Multivariate analysis and subsequent subanalysis across age categories confirmed prematurity as an independent predictor of overall complications (adjusted odds ratio: 1.76; 95% confidence interval: 1.23-2.53) and related reoperations (adjusted odds ratio: 2.12; 95% confidence interval: 1.30-3.46) in children less than 1 y of age.
Conclusions:
Premature birth is associated with increased complications and related reoperations following pull-through surgery for HD. These findings suggest that prematurity should be considered when managing postoperative care in this population.
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