Patient-reported outcomes of Children with an Anorectal Malformation
Expert / Speaker
an Anorectal Malformation
General Surgery
Topic overview
Richard J Wood, Shruthi Srinivas, Misel Trajanovska, Brennan J Collis, Reuben Lim, Molly Fuchs, Daniel Dajusta, Chris Westgarth-Taylor, Ihab Halaweish, Alessandra A Gasior, Marc A Levitt, John M Hutson, Sebastian K King
Objective: We aimed to study the impact of anorectal malformation (ARM) type and sacral ratio on continence outcomes in children. We secondarily aimed to compare continence outcomes by age group and determine quality of life (QoL) with different bowel regimens.
Summary background data: Children with ARM experience dysfunctional stooling into adulthood. Little is known about how ARM type, sacral ratio, age, and bowel regimen affect continence and QoL.
Methods: We administered five validated survey measures on stooling habits and QoL to children aged 2-19 with ARM at two tertiary hospitals. Sacral ratio as a determinant of sacral hypodevelopment was defined as normal (≥0.7), moderate (0.4-0.0.69), or severe (≤0.39). Children not on an enema program were compared to those on an enema program to identify factors associated with achieving voluntary bowel movements defined as continence. All children were compared to identify factors associated with QoL.
Results: Of 910 patients, half (52.8%) had mild sacral hypodevelopment. In patients not receiving enemas managed solely at study hospitals, most were continent (69.2%). There were no differences in continence demonstrated by sacral ratio; 79.4% of those who were continent had normal/moderate sacral hypodevelopment and mild ARM.Continence improved with age (50% ≤6 y old, 69.8% 6-12 y old, 82.1% >12 y old; P<0.001). Those on enemas and soiling had a QoL 19.6 points lower than those soiling on laxatives, and 20.7 points lower than those who were clean on enemas or continent with voluntary bowel movements without the need for enemas.
Conclusions: In patients on laxatives the type of malformation, but not sacral ratio, is associated with continence in patients with ARM. Continence improves with age; those on enemas with soiling have a worse QoL.
Intended audience: Healthcare professionals and clinicians.
Categories
Specialty
Anatomy/Organ System
Care Context
Topic Format
Clinical Task
Keywords
anal rectal malformation
sacral ratio
incontinence
quality of life
bowel function
pediatric surgery
surgical outcomes
patient counseling
clinical survey
Annals of Surgery
sacral ratio predictor
patient quality of life
enemas
continency
surgical management
patient care
pediatric patients
malformation management
health outcomes
surgical predictors
Hashtags
#AnalRectalMalformation
#SacralRatio
#Incontinence
#QualityOfLife
#BowelFunction
#PediatricSurgery
#SurgicalOutcomes
#PatientCounseling
#ClinicalSurvey
#AnnalsOfSurgery
#PatientCare
#SurgicalManagement
#HealthOutcomes
#Continency
#Enemas
#PediatricPatients
#MalformationManagement
#SurgicalPredictors
#MedicalEducation
#StayCurrentMD
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Speaker: an Anorectal Malformation
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