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Rates of post-operative complications in Hirschsprung disease: A study by the Canadian Consortium for Research in
Ehab Ergsous1, Jacob Davidson1, Natashia Seemann1
1Division of Paediatric Surgery, Children's Hospital, London Health Sciences Centre, Western University, 800 Commissioners Road East, London, ON, N6A 5W9, Canada.
Insights
Canadian children undergoing surgery for Hirschsprung disease (HD) experienced high rates of reoperation and readmission. While major complications like Hirschsprung-associated enterocolitis (HAEC) were infrequent, these outcomes highlight areas for improved postoperative care.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Public Health
Background:
- Outcomes following surgery for Hirschsprung disease (HD) show considerable variability in existing literature, often based on single-center data.
- A comprehensive understanding of postoperative complication rates in a large, population-based cohort is needed to guide clinical practice.
- Canadian children represent a significant demographic for studying HD surgical outcomes.
Purpose of the Study:
- To determine the population-based rates of postoperative complications in Canadian children who underwent surgery for Hirschsprung disease (HD).
- To analyze the types and frequencies of complications, including reoperation, readmission, and specific surgical complications.
- To evaluate the impact of age at surgery on postoperative outcomes.
Main Methods:
- A multi-center, retrospective review was conducted involving 227 children diagnosed with HD from six Canadian children's hospitals.
- Data collection spanned from 2010 to 2022, with a minimum follow-up period of six months post-surgery.
- Surgical approaches included laparoscopic, transanal, and open procedures.
Main Results:
- The cohort included 227 patients, with a median age of 1 week at diagnosis and 2 months at pull-through surgery; 81% were male.
- High rates of reoperation (31.3%) and readmission (41.4%) were observed, with Hirschsprung-associated enterocolitis (HAEC) being the most common reason for readmission (30.0%).
- Surgery-specific complications occurred in 15.0% of patients, including stricture (6.2%) and HAEC (17.2%); complication rates did not vary based on surgery timing (before vs. after one month of age).
Conclusions:
- This population-based study in Canada reveals significant rates of reoperation and readmission following Hirschsprung disease surgery, despite low incidences of HAEC, stricture, and anastomotic leak.
- A novel management-based classification for stricture is proposed to improve patient stratification.
- Further prospective studies are recommended to validate this classification and establish more precise rates of postoperative complications after pull-through surgery for HD.
Purpose:
Morbidity and mortality following surgery for Hirschsprung disease (HD) vary widely in the literature and largely emanate from single center studies. We conducted a population-based study of postoperative complication rates in Canadian children.
Methods:
A multi-centre, retrospective review of children with HD from six Canadian children's hospitals was performed. Data was collected between 2010 and 2022. Patients were included if they had at least six months of follow-up.
Results:
The study cohort included 227 patients. The median age at diagnosis was 1 week (interquartile range [IQR]:1-2) and 81.0% were male. The median age at time of pull-through was two months (IQR:1-7). The most common surgical approach was laparoscopic (63.2%), with the remaining procedures being transanal (27.3%), and open (9.5%). The rate of reoperation was 31.3%, of which 63.4% were minor procedures and 36.6% were major procedures. The rate of readmission was 41.4%, with the most common reason being Hirschsprung-associated enterocolitis (HAEC) (30.0%). Surgery-specific complications occurred in 15.0% of patients. These included stricture at 12-weeks (6.2%), anastomotic leak (0.9%), and HAEC (17.2%). Complication rates did not differ between patients who underwent surgery before or after one month of age.
Conclusion:
In this Canadian population-based study, significant rates of reoperation and readmission were found, despite overall low rates of complications (HAEC, stricture and leak). A new management-based classification of stricture is proposed to aid in stratification of patients. Prospective studies will aim to validate this approach and provide more meaningful rates of postoperative complications following pull-through for HD.
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