Eur J Pediatr Surg 2021; 31(03): 207-213
DOI: 10.1055/s-0040-1716876
Original Article

Comparison of Hirschsprung Disease Characteristics between Those with a History of Postoperative Enterocolitis and Those without: Results from the Pediatric Colorectal and Pelvic Learning Consortium

1   Department of Surgery, University of Utah School of Medicine and Primary Children's Hospital, Salt Lake City, Utah, United States
,
Brian T. Bucher
1   Department of Surgery, University of Utah School of Medicine and Primary Children's Hospital, Salt Lake City, Utah, United States
,
Ron W. Reeder
2   Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, United States
,
Jeffrey R. Avansino
3   Department of Pediatric Surgery, Seattle Children's, Seattle, Washington, United States
,
Megan Durham
4   Division of Pediatric Surgery, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, United States
,
Casey M. Calkins
5   Department of Pediatric Surgery, Children's Wisconsin, Milwaukee, Wisconsin, United States
,
Richard J. Wood
6   Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, Columbus, Ohio, United States
,
Marc A. Levitt
7   Department Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, District of Columbia, Washington, United States
,
Kaylea Drake
2   Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, United States
,
Michael D. Rollins
1   Department of Surgery, University of Utah School of Medicine and Primary Children's Hospital, Salt Lake City, Utah, United States
› Author Affiliations

Abstract

Introduction The current understanding of Hirschsprung-associated enterocolitis (HAEC) is based mainly on single-center, retrospective studies. The aims of this study are to determine risk factors for postoperative HAEC using the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) database.

Materials and Methods We performed a multicenter, retrospective, case–control study of children with Hirschsprung disease (HD) who had undergone a pull-through procedure and were evaluated at a PCPLC member site between February 2017 and March 2020. The cohort with a history of postoperative HAEC was compared with that without postoperative episodes of HAEC to determine relevant associations with postoperative HAEC.

Results One-hundred forty of 299 (46.8%) patients enrolled had a history of postoperative HAEC. Patients with a rectosigmoid transition zone had a lower association with postoperative HAEC as compared with those with a more proximal transition zone (odds ratio [OR]: 0.46, 95% confidence interval [CI]: 0.26, 0.84, p < 0.01). Private insurance was protective against postoperative HAEC on univariate analysis (OR: 0.62, 95% CI: 0.38, 0.99, p = 0.047), but not on multivariate analysis (OR: 0.62, 95% CI: 0.37, 1.04, p = 0.07). Preoperative HAEC was not associated with the development of postoperative HAEC.

Conclusion Patients with a rectosigmoid transition zone have less postoperative HAEC compared with patients with a more proximal transition zone. Multi-institutional collection of clinical information in patients with HD may allow for the identification of additional risk factors for HAEC and afford the opportunity to improve care.



Publication History

Received: 06 May 2020

Accepted: 16 August 2020

Publication Date:
18 September 2020 (online)

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