Nationwide Outcomes of Immediate Versus Staged Surgery for Newborns with Rectosigmoid Hirschsprung Disease

Infographic · Sep 2023 · 1 min read

In brief

Nationwide database analysis of 1,048 newborns with rectosigmoid Hirschsprung disease found that staged surgery resulted in 40% unplanned readmission rates versus 23% for immediate resection, with higher costs and more enterocolitis complications. Findings support immediate definitive surgery during newborn hospitalization to reduce healthcare utilization and postoperative morbidity.

Immediate surgery for rectosigmoid Hirschsprung disease in newborns reduces total hospitalization costs by ~$6,500 compared to staged approach
Staged resection increases unplanned readmission risk (40% vs 23%) and gastrointestinal complications including enterocolitis (35% vs 20%)
Newborns undergoing staged HD surgery require home healthcare at discharge more frequently than those receiving immediate resection
Immediate definitive surgery during newborn hospitalization may optimize outcomes and resource utilization for rectosigmoid Hirschsprung disease

Written by the GCMD Library team from the infographic.

The infographic uses a three-panel layout with a red sidebar on the left containing study metadata. The center panel shows an illustration of a neonate with rectosigmoid Hirschsprung disease and depicts the immediate surgery pathway with icons for newborn, surgery, and hospital. The right panel displays three outcome metrics with downward arrows in teal, showing improvements in readmissions, cost, and complications.

New infographic by Dr. Jose Campos and the Chilean Society of Pediatric Surgery

"Nationwide Outcomes of Immediate Versus Staged Surgery for Newborns with Rectosigmoid Hirschsprung Disease"

Authors: Carlos Theodore Huerta, Walter A. Ramsey, Jenna K. Davis, Rebecca A. Saberi, Gareth P. Gilna, Joshua P. Parreco, Juan E. Sola, Eduardo A. Perez, Chad M. Thorson

Full Article: https://doi.org/10.1016/j.jpedsurg.2023.02.014

Purpose

Debate exists on whether patients with Hirschsprung Disease (HD) should undergo immediate resection during their newborn hospitalization or undergo a staged procedure. This study sought to compare postoperative outcomes among newborns receiving immediate versus staged surgery for rectosigmoid HD.

Methods

The Nationwide Readmission Database was queried (2016–2018) for newborns with HD who underwent surgical resection during their newborn hospitalization (immediate) versus planned readmission (staged). Those who did not receive rectal biopsy or had long-segment or total colonic HD were excluded. A propensity score-matched analysis (PSMA) of patients receiving either surgery was constructed utilizing >70 comorbidities. Outcomes were analyzed using standard statistical tests.

Results

1,048 newborns with HD were identified (56% immediate vs. 44% staged). Staged resection was associated with higher total hospitalization cost ($56,642 vs. $50,166 immediate), p = 0.014. After PSMA, the staged cohort was more likely to require home healthcare at discharge and experience unplanned readmission (40% vs. 23%). These patients experienced more gastrointestinal complications (40% vs. 22%) on readmission, especially Hirschsprung-associated enterocolitis (35% vs. 20%).

Conclusion

Newborns receiving staged procedures for HD experience higher rates of unplanned readmission complications and incur higher hospitalization costs. This information should be utilized to defray healthcare utilization costs for newborns with HD.

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