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Delay in operation for Hirschsprung Disease is associated with decreased length of stay: a 5-Year NSQIP-Peds analysis

Journal of Perinatology volume 39, pages 1105–1110 (2019)Cite this article

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Abstract

Objective

The optimal timing of a pull-through procedure for Hirschsprung Disease is unknown. We, therefore, compared outcomes of pull-throughs performed in the first 30 days of age to 31–120 days.

Study design

Retrospective review of 282 patients in the NSQIP-Peds database from 2012–2016 of infants ≤120-days old and >36-weeks gestational age with Hirschsprung Disease who underwent primary pull-through. Primary outcome was postoperative and total length of stay (LOS). Operative morbidity and readmissions were also compared.

Results

Postoperative LOS in <31-day group was 8.3 days (SD- 8.3) vs. 4.3 days (SD- 5.5) in 31–120-day group (p < 0.001). This finding was maintained on multivariate linear regression. Complication and readmission rates did not differ between groups (readmission: 15.6 vs 13% p = 0.51; complication: 5.5 vs 10% p = 0.16).

Conclusion

For appropriately selected patients with Hirschsprung Disease, delaying pull-through until the second month of life is associated with lower total and postoperative stays without increased readmissions or complications.

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References

  1. Hirschsprung H Stuhlträgheit neugeborener infolge von dilatation und hypertrophic des colons. Jahrb Kinderh 1888;27:1–7.

  2. Skaba R. Historic milestones of Hirschsprung’s disease (commemorating the 90th anniversary of Professor Harald Hirschsprung’s death). J Pediatr Surg. 2007;42:249–51.

    Article  Google Scholar 

  3. Amiel J, Lyonnet S. Hirschsprung disease, associated syndromes, and genetics: a review. J Med Genet. 2001;38:729–39.

    Article  CAS  Google Scholar 

  4. Kenny SE, Tam PK, Garcia-Barcelo M. Hirschsprung’s disease. Semin Pediatr Surg. 2010;19:194–200.

    Article  Google Scholar 

  5. Swenson O, Bill AH Jr. Resection of rectum and rectosigmoid with preservation of the sphincter for benign spastic lesions producing megacolon; an experimental study. Surgery. 1948;24:212–20.

    CAS  PubMed  Google Scholar 

  6. Somme S, Langer JC. Primary versus staged pull-through for the treatment of Hirschsprung disease. Semin Pediatr Surg. 2004;13:249–55.

    Article  Google Scholar 

  7. Langer JC. Hirschsprung Disease. In: Holcom GW (ed). Ashcraft’s Pediatric Surgery, vol. 6, 2014, pp 479–91.

  8. Huang EY, Tolley EA, Blakely ML, Langham MR. Changes in hospital utilization and management of Hirschsprung disease: analysis using the kids’ inpatient database. Ann Surg. 2013;257:371–5.

    Article  Google Scholar 

  9. Hackam DJ, Superina RA, Pearl RH. Single-stage repair of Hirschsprung’s disease: a comparison of 109 patients over 5 years. J Pediatr Surg. 1997;32:1028–31. discussion 1031–32.

    Article  CAS  Google Scholar 

  10. Cilley RE, Statter MB, Hirschl RB, Coran AG. Definitive treatment of Hirschsprung’s disease in the newborn with a one-stage procedure. Surgery. 1994;115:551–6.

    CAS  PubMed  Google Scholar 

  11. Pini Prato A, Gentilino V, Giunta C, Avanzini S, Mattioli G, Parodi S, et al. Hirschsprung disease: do risk factors of poor surgical outcome exist? J Pediatr Surg. 2008;43:612–9.

    Article  Google Scholar 

  12. Moore SW. Total colonic aganglionosis in Hirschsprung disease. Semin Pediatr Surg. 2012;21:302–9.

    Article  Google Scholar 

  13. Bufo AJ, Chen MK, Shah R, Gross E, Cyr N, Lobe TE. Analysis of the costs of surgery for Hirschsprung’s disease: one-stage laparoscopic pull-through versus two-stage Duhamel procedure. Clin Pediatr. 1999;38:593–6.

    Article  CAS  Google Scholar 

  14. Xiao S, Yang W, Yuan L, Zhang Y, Song T, Xu L, et al. Timing investigation of single-stage definitive surgery for newborn with Hirschsprung’s disease. Zhonghua wei chang wai ke za zhi = Chin J Gastrointest Surg. 2016;19:1160–4.

    Google Scholar 

  15. Langer JC, Fitzgerald PG, Winthrop AL, Srinathan SK, Foglia RP, Skinner MA, et al. One-stage versus two-stage Soave pull-through for Hirschsprung’s disease in the first year of life. J Pediatr Surg. 1996;31:33–6. discussion 36–7.

    Article  CAS  Google Scholar 

  16. So HB, Schwartz DL, Becker JM, Daum F, Schneider KM. Endorectal “pull-through” without preliminary colostomy in neonates with Hirschsprung’s disease. J Pediatr Surg. 1980;15:470–1.

    Article  CAS  Google Scholar 

  17. Kim HY, Oh JT. Stabilization period after 1-stage transanal endorectal pull-through operation for Hirschsprung disease. J Pediatr Surg. 2009;44:1799–804.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Yale School of Medicine, New Haven, CT, USA

    Mollie R. Freedman-Weiss, Alexander S. Chiu, Michael G. Caty & Daniel G. Solomon

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  1. Mollie R. Freedman-Weiss
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  2. Alexander S. Chiu
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Contributions

Mollie Freedman-Weiss- Designed the work, drafted the manuscript, approved the final version. Alexander S Chiu—acquired the data, revised the manuscript, approved of the final version. Michael G. Caty—Played an important role in interpreting results, revised the manuscript, approved of the final version. Daniel Solomon—Conceived of the work, revised the manuscript, approved of the final version

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Correspondence to Daniel G. Solomon.

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Freedman-Weiss, M.R., Chiu, A.S., Caty, M.G. et al. Delay in operation for Hirschsprung Disease is associated with decreased length of stay: a 5-Year NSQIP-Peds analysis. J Perinatol 39, 1105–1110 (2019). https://doi.org/10.1038/s41372-019-0405-y

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