Prognostic factors of postoperative Hirschsprung-associated enterocolitis: a cohort study
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In brief
In brief
This cohort study of 274 Hirschsprung patients identifies key risk factors for postoperative enterocolitis, including extensive aganglionic segments and early postoperative HAEC episodes. Patients with total colonic aganglionosis showed 15-fold increased risk, emphasizing the need for intensive monitoring and parental education in high-risk cases.
Written by the GCMD Library team from the article.
Abstract
Purpose
To identify prognostic factors of postoperative Hirschsprung-associated enterocolitis (HAEC).
Method
A retrospective cohort study of Hirschsprung patients between 2006 and 2021 was conducted. Patients with anorectal malformation and non-definitive surgery were excluded. Associated factors for postoperative HAEC were reported with hazard ratio (HR) and 95% confidence interval (CI).
Results
Forty-nine patients were excluded due to concurrent anorectal malformation and incomplete data. Of 274 patients, 75 patients (27.4%) had at least one episode of postoperative HAEC. There were 28 patients (37.3%) who had multi-episodes of HAEC. The total episodes of post-operative HAEC in this study were 121 episodes (36.8%). In multivariable survival analysis, significant factors associated with postoperative HAEC were the aganglionic level above sigmoid colon (HR = 3.47, p = 0.023, 95% CI 1.19–10.09), and total colonic aganglionosis (HR = 14.83, p = 0.004, 95% CI 2.33–94.40). The patients who experienced clinical enterocolitis before 2 weeks after surgery significantly developed more postoperative HAEC (HR = 5.32, p = 0.038, % CI 1.09–25.92). The incidence of postoperative HAEC was increase in patients with postoperative obstructive symptoms (48.0%). One patient died due to severe sepsis from postoperative HAEC, while three others required intensive care.
Conclusions
The long involvement of aganglionic segment and early postoperative HAEC was significantly associated with postoperative HAEC. Frequent follow-up, parental education, and early treatment are recommended in these individuals, particularly in the first year after surgery.