Outcomes of Primary versus Multiple-Staged Repair in Hirschsprung's Disease in England.

Abstract

INTRODUCTION:

 The study aimed to compare 1-year outcomes for primary versus multiple-staged (three operations with colostomy) repairs in Hirschsprung's disease (HD).

MATERIALS AND METHODS:

 Retrospective analysis of a large national administrative database (Hospital Episode Statistics) including all the neonates born with HD in England between 2003 and 2015. Main outcomes were: 1-year mortality, postoperative readmissions, and reoperations.

SECONDARY OUTCOMES:

cumulative length of hospital stay (cLOS) and hospital volume-outcome relationship.

RESULTS:

 A total of 1,333 neonates with HD were treated in 21 specialist pediatric surgical centers; 874 (65.5%) patients had a primary repair for HD. One-year mortality was 2.8%. The overall readmission rate was 70.2%, with a significant difference between primary and multiple-staged repair (79.9 vs. 90.1%, p < 0.01). There was no difference in reoperation. Primary pull-through was associated with a significantly lower probability of postoperative readmission (odds ratio [OR] = 0.08, 95% confidence interval [CI] = 0.06-0.11, p < 0.001) and cLOS (OR = 0.38, 95% CI = 0.28-0.52, p < 0.001) compared with multiple-staged repair. There were no significant difference in outcomes between patients treated in low-volume (<37 cases/year) and high-volume (> 55 cases/year) specialist centers.

CONCLUSION:

 Whenever clinically indicated, primary repair should be used in HD as this is associated with fewer readmissions and shorter time spent in the hospital.

• Authors: Stefano Giuliani, Kate Honeyford, Chieh-Yu Chang, Alex Bottle, Paul Aylin
• Journal: European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie (Eur J Pediatr Surg) Vol. 30 Issue 1 Pg. 104-110 (Feb 2020) ISSN: 1439-359X [Electronic] United States
• PMID: 31910450 (Publication Type: Journal Article)
• Copyright: Georg Thieme Verlag KG Stuttgart · New York.

Topics

• Colostomy
• Digestive System Surgical Procedures (adverse effects, methods)
• England (epidemiology)
• Female
• Hirschsprung Disease (mortality, surgery)
• Hospitals, Pediatric (statistics & numerical data)
• Humans
• Infant, Newborn
• Length of Stay
• Male
• Patient Readmission
• Postoperative Complications
• Reoperation
• Retrospective Studies
• Treatment Outcome