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Sex Differences in Postoperative Outcomes of Hirschsprung Disease: Propensity Score Matching Analysis
Wei Feng1, Yuanyuan Liu1, Xiaohong Die1
1Department of General & Neonatal Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China.
Purpose:
Sex differences in Hirschsprung disease (HSCR) incidence have been well documented, yet little is known about whether the effect of sex on postoperative outcomes. This study aims to investigate the sex differences of postoperative outcomes of HSCR using propensity score matching (PSM) analysis.
Methods:
Retrospective review of 304 patients with HSCR who received single-stage laparoscopic transanal pull-through modified Swenson procedure in a single-center was conducted with assessments of clinical data. By using PSM, baseline characteristics and postoperative outcomes between different sexes were compared. Furthermore, Univariate/multivariate Logistic regression analysis was used to identify sex as an independent factor of postoperative complications within 30 days and bowel dysfunction.
Results:
Of the 304 patients, the proportion of females was 18.1 % (55/304). After one-to-one PSM, results showed that female patients had significantly longer length of postoperative hospital stay (12.60 ± 4.13 days vs. 10.62 ± 2.83 days, P = 0.005), lower health-related quality of life score (93.9 ± 4.2 vs. 97.3 ± 3.3, P < 0.001), higher rates of postoperative complications within 30 days (31 % vs. 13 %, P = 0.033) and bowel dysfunction (65.4 % vs. 36.5 %, P = 0.003) than males. However, statistically insignificant differences were observed among females and males in the surgical time, severity of complications, postoperative nutritional status, Hirschsprung-associated enterocolitis, and health-related quality of life (HRQoL) in physical and social domains (all P > 0.05). Furthermore, Multivariate Logistic regression analysis revealed that female was an independent risk factor for postoperative complications within 30 days (OR = 5.065, P = 0.024) and bowel dysfunction (OR = 3.153, P = 0.019).
Conclusions:
Following adjustment for HSCR patient characteristics, females may face more severe postoperative outcomes than males. In clinical practice, pediatric surgeons should pay more attention to these differences and develop individualized response measures, eg. optimizing the preoperative nutritional status and surgical procedure, formulating gender-specific strategies for defecation function management and perineal-anal care, and emphasizing the dynamic assessment of HRQoL.
Level Of Evidence:
Level 4.
