Quantifying the impact of congenital cardiac co-morbidities on anorectal malformations

Anorectal malformations (ARM) are frequently associated with congenital heart defects (CHD) (prevalence 10-40 %). Cardiac ARM patients, particularly those requiring surgery, tend to experience delays in definitive anorectal reconstruction whilst awaiting favourable cardiac status. We sought to quantify these delays and evaluate CHD's impact on surgical complications.

ARM patients treated at a single cardiac centre were identified through a prospectively maintained database. A consultant cardiologist reviewed all patient cardiac studies and divided them into either a cardiac or non-cardiac group based on their functional status ± need for cardiac surgery. Demographics, ARM classification, surgical history, and complications were analysed using SPSS (IBMv31). Mann-Whitney-U and Chi-squared tests evaluated continuous and categorical variables, respectively. Complication counts were stratified by surgical time-point, with odds ratios calculated (p < 0.05 = significant).

62 ARM patients were identified over 7 years (2018-2024); cardiac (n = 19) and non-cardiac (n = 43). Cardiac patients underwent definitive anorectal reconstruction when significantly older (396 vs. 175 days, p < 0.001), even after adjusting for birthweight and gestation (p = 0.002). One or more complication occurred in 47 % of cardiac patients versus 27 % of non-cardiac patients (OR 2.33, 95 % CI 0.76-7.13, p = 0.136), an insignificant difference. Cardiac status was however a statistically significant predictor of total complication count (Wald χ² = 4.049, p = 0.044), with Poisson regression models showing cardiac patients had 2.11 times the rate of complications compared to non-cardiac patients (Incidence Rate Ratio/IRR = 2.11, 95 % CI: 1.23-4.37). Each additional day from stoma formation to closure increased complication likelihood by 0.4 % (OR 1.004, 95 % CI 1.000-1.008, p = 0.029).

Cardiac ARM patients undergo definitive reconstruction significantly laterwith a greater proportion suffering complications compared with their non-cardiac counterparts. Quantifying these delays and risks provides clinicians with data to guide prognostic counselling, proactively address psychosocial burdens, and refine multidisciplinary protocols shaping the ARM-CHD patients' surgical journey. Further work is crucial to disentangling relationships between CHD severity, circulatory physiology, and clinician imposed surgical delay to better define their exact contributions to risk.