Huerta Carlos Theodore, Ramsey Walter A, Davis Jenna K, Saberi Rebecca A, Gilna Gareth P, Parreco Joshua P, Sola Juan E, Perez Eduardo A, Thorson Chad M
DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
University of Miami Miller School of Medicine, Miami, FL, USA.
J Pediatr Surg. 2023 May;58(5):849-855. doi: 10.1016/j.jpedsurg.2023.01.001. Epub 2023 Jan 5.
Hirschsprung Disease (HD) is a common congenital intestinal disorder. While aganglionosis most commonly affects the rectosigmoid colon (rectosigmoid HD), outcomes for patients in which aganglionosis extends to more proximal segments (long-segment HD) remain understudied. This study sought to compare postoperative outcomes among newborns with rectosigmoid and long-segment HD.
The Nationwide Readmission Database was queried from 2016 to 2018 for newborns with HD. Newborns were stratified into those with rectosigmoid or long-segment HD. Those who received no rectal biopsy or pull-through procedure during their newborn hospitalization were excluded. A propensity score-matched analysis (PSMA) of newborns with either type of HD was constructed utilizing 17 covariates including demographics, comorbidities, and congenital-perinatal conditions.
There were 1280 newborns identified with HD (82% rectosigmoid HD, 18% long-segment HD). Patients with rectosigmoid HD had higher rates of laparoscopic resections (35% vs. 12%) and less frequently received a concomitant ostomy (14% vs. 84%), both p < 0.001. Patients with long-segment HD were more likely to have a delayed diagnosis (12% vs. 5%) and require multiple bowel operations (19% vs. 4%), both p < 0.001. They experienced higher rates of complications, including small bowel obstructions (10% vs. 1%), infections (45% vs. 20%), and Hirschsprung-associated enterocolitis (11% vs. 5%), all p < 0.001. After PSMA, newborns with long-segment HD were found to have a longer length of stay and higher hospitalization costs.
Newborns with long-segment HD experience significant delays in diagnosis, surgery, and complications compared to those with rectosigmoid HD. This information should be utilized to improve healthcare delivery for this patient population.
Retrospective comparative study.
III.
先天性巨结肠（HD）是一种常见的先天性肠道疾病。虽然无神经节细胞症最常累及直肠乙状结肠（直肠乙状结肠型HD），但无神经节细胞症延伸至更近端节段（长段型HD）患者的预后仍研究不足。本研究旨在比较直肠乙状结肠型和长段型HD新生儿的术后结局。
查询2016年至2018年全国再入院数据库中患有HD的新生儿。将新生儿分为直肠乙状结肠型或长段型HD。排除在新生儿住院期间未接受直肠活检或拖出术的患儿。利用包括人口统计学、合并症和先天性围产期状况在内的17个协变量，对两种类型HD的新生儿进行倾向评分匹配分析（PSMA）。
共确定1280例患有HD的新生儿（82%为直肠乙状结肠型HD，18%为长段型HD）。直肠乙状结肠型HD患者腹腔镜切除术的比例更高（35%对12%），同时接受造口术的频率更低（14%对84%），两者p均<0.001。长段型HD患者更有可能延迟诊断（12%对5%）并需要多次肠道手术（19%对4%），两者p均<0.001。他们的并发症发生率更高，包括小肠梗阻（10%对1%）、感染（45%对20%）和先天性巨结肠相关小肠结肠炎（11%对5%），所有p均<0.001。PSMA后发现，长段型HD新生儿的住院时间更长，住院费用更高。
与直肠乙状结肠型HD新生儿相比，长段型HD新生儿在诊断、手术和并发症方面有明显延迟。这些信息应用于改善该患者群体的医疗服务。
回顾性比较研究。
III级。
