Outcomes of Primary versus Multiple-Staged Repair in Hirschsprung's Disease in England
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In brief
In brief
Nationwide study analyzing postoperative outcomes and hospital readmissions in children undergoing pull-through surgery for Hirschsprung disease using 2010-2014 data. Research identifies key determinants affecting discharge outcomes and readmission patterns in this pediatric surgical population.
Written by the GCMD Library team from the article.
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.