Age and Weight Stratified Outcomes of Single Stage Endorectal Pull-through Procedures for Hirschsprung's Disease in Children: Analysis of NSQIP-P Data

Humza Thobani, Daniel Tahan, Adil A. Shah, Steven L. Raymond, Bill Chiu, Saleem Islam, Faraz A. Khan

Research output: Contribution to journalArticlepeer-review

Abstract

Background: We aimed to analyze the effect of age and weight on 30-day outcomes of single-stage endorectal pull tthrough (ERPT) procedures for Hirschsprung's Disease (HD) using the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database to identify an optimal time for surgery. Methods: We queried NSQIP-P for children <2 years with HD who underwent ERPT between 2016-2021 and did not have a preoperative stoma. Patients were stratified by age (<3 months, 3–6 months and >6 months) and weight (<4 kg, 4–8 kg, and >8 kg) at the time of surgery. The primary outcome measure was major adverse outcomes, and the secondary outcomes were 30-day unplanned readmission and reoperation. Multivariable logistic regression was conducted to analyze the association between age and weight and each outcome. Results: A total of 1002 patients were included with a median age of 31 days (IQR: 10–106 days). Patients were stratified by age (n = 702, 70.1 %; n = 158, 15.8 %; n = 142, 14.2 % respectively from youngest to oldest) and weight (n = 472, 47.1 %; n = 421, 42.0 %; n = 109, 10.9 % respectively from lowest to highest weight) groups. On multivariable analysis, age>6 months and weight>8 kg were independently associated with a higher rate of major complications (aOR = 2.741, 95 % C.I. = 1.234–5.880 and aOR = 4.627, 95 % C.I. = 1.761–11.775 respectively). Conversely, being in the highest age (aOR = 0.359, 95 % C.I. = 0.176–0.699) and weight brackets (aOR = 0.396, 95 % C.I. = 0.171–0.801) independently predicted lower 30-day readmission rates. Conclusion: Earlier single-stage ERPT for HD was found to be associated with lower complication rates in a select group of patients but may result in increased rates of readmissions and hospital resource utilization. Level of Evidence: Level III evidence. Type of Study: Retrospective cohort study.

Original languageEnglish
Article number162168
JournalJournal of Pediatric Surgery
DOIs
Publication statusAccepted/In press - 2025

Keywords

  • Age
  • Endorectal pull-through
  • Hirschsprung disease
  • Outcomes
  • Timing
  • Weight

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