Benefits of standardized care for Hirschsprung's associated enterocolitis

Infographic · Mar 2021 · 1 min read

In brief

Standardized care algorithm for Hirschsprung-associated enterocolitis significantly reduced hospital length of stay from 7 to 2 days and TPN duration without increasing readmissions. Study demonstrates value of protocol-driven management in reducing healthcare utilization while maintaining quality outcomes.

Standardized HAEC treatment algorithm reduced median length of stay from 7 to 2 days without increasing readmission rates
Algorithm implementation decreased TPN duration from 5.5 to 0 days and time to full feeds from 6 to 2 days
59% of HSCR patients experienced recurrent HAEC episodes, highlighting need for consistent management protocols
Standardized care pathway safely reduces IV antibiotic duration while maintaining appropriate treatment for enterocolitis

Written by the GCMD Library team from the infographic.

The infographic uses a red and gray color scheme with a large title banner at top. A simplified intestinal diagram appears on the left. The center shows a before/after comparison with a flowchart icon between two time periods. Four columns display hospital icons and IV bag illustrations with large numerical comparisons showing reductions in days (arrows pointing from higher to lower values in red).

Abstract

Introduction: Patients with Hirschsprung's disease (HSCR) remain at risk of developing Hirschsprung-associated enterocolitis (HAEC) after surgical intervention. As inpatient management remains variable, our institution implemented an algorithm directed at standardizing treatment practices. This study aimed to compare the outcomes of patients pre- and post-algorithm.

Methods: A retrospective review of patients admitted for HAEC was performed; January 2017-June 2018 encompassed the pre-implementation period, and October 2018-October 2019 was the post-implementation period. Demographics and outcomes were compared between the two groups.

Results: Sixty-two episodes of HAEC occurred in 27 patients during the entire study period. Sixteen patients (59%) had more than one episode. The most common levels of the transition zone were the rectosigmoid (50%) and descending colon (27%). Following algorithm implementation, the median length of stay (2 vs. 7 days, p < 0.001), TPN duration (0 vs. 5.5 days, p < 0.001), and days to full enteral diet (6 days vs. 2 days, p < 0.001) decreased significantly. Readmission rates for recurrent enterocolitis were similar pre- and post-algorithm implementation.

Conclusion: The use of a standardized algorithm significantly decreases the length of stay and duration of intravenous antibiotic administration without increasing readmission rates, while still providing appropriate treatment for HAEC.

Level of evidence: III level.

Type of study: Retrospective comparative study.

Keywords: Colorectal; Enterocolitis; Hirschsprung disease; Pediatric.

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