Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Department of Pediatric Surgery, Skåne University Hospital Lund, Lund, Sweden.
Pediatr Surg Int. 2024 Oct 5;40(1):265. doi: 10.1007/s00383-024-05842-6.
In Sweden, surgical treatment of Hirschsprung's disease (HSCR) was centralized from four to two pediatric surgery centers 1st of July 2018. In adults, centralization of surgical care for complex or rare diseases seems to improve quality of care. There is little evidence supporting centralization of pediatric surgical care. The aim of this study was to assess surgical management and postoperative outcome in HSCR patients following centralization of care.
This study retrospectively analyzed data of patients with HSCR that had undergone pull-through at a pediatric surgery center in Sweden from 1st of July 2013 to 30th of June 2023. Patients managed from 1st of July 2013 to 30th of June 2018 (before centralization) were compared with patients managed from 1st of July 2018 to 30th of June 2023 (after centralization) regarding surgical treatment, unplanned procedures under general anesthesia or readmissions up to 90 days after pull-through as well as complications classified according to Clavien-Madadi up to 30 days after pull-through.
In the 5-year period prior to centralization, 114 individuals from 4 treating centers were included and compared to 83 patients from 2 treating centers in the second period. There was no difference regarding age at pull-through or proportion of patients with a stoma prior to pull-through. An increase of laparoscopically assisted endorectal pull-through (8.8% to 39.8%) was observed (p < 0.001). No significant differences were seen in postoperative hospital stay, unplanned procedures under general anesthesia, or readmissions up to 90 days after pull-through. There was no difference in severe complications (Clavien-Madadi ≥ 3); however, HAEC treated with antibiotics increased following centralization (10.5-24.1%; p = 0.018).
Centralization of care for HSCR does not seem to delay time to pull-through nor reduce severe complications, unplanned procedures under general anesthesia or readmissions up to 90 days after pull-through. The increased HAEC rate may be due to increased awareness of mild HAEC.
Level III.
2018 年 7 月 1 日起，瑞典将小儿先天性巨结肠症（HSCR）的外科治疗从 4 个中心集中到 2 个儿科外科中心。在成人中，集中治疗复杂或罕见疾病似乎可以提高护理质量。很少有证据支持集中儿科外科护理。本研究旨在评估集中护理后 HSCR 患者的手术管理和术后结果。
本研究回顾性分析了瑞典一家儿科外科中心从 2013 年 7 月 1 日至 2023 年 6 月 30 日接受经肛门拖出术的 HSCR 患者的数据。将 2013 年 7 月 1 日至 2018 年 6 月 30 日（集中前）接受治疗的患者与 2018 年 7 月 1 日至 2023 年 6 月 30 日（集中后）接受治疗的患者进行比较，比较内容包括手术治疗、全麻下非计划手术或经肛门拖出术后 90 天内再入院情况以及经肛门拖出术后 30 天内按 Clavien-Madadi 分类的并发症。
在集中前的 5 年期间，纳入了来自 4 个治疗中心的 114 名患者，并与第二个时期来自 2 个治疗中心的 83 名患者进行了比较。两组患者在经肛门拖出术时的年龄或术前造口的比例方面无差异。腹腔镜辅助经肛门拖出术的比例有所增加（8.8%至 39.8%）（p<0.001）。经肛门拖出术后住院时间、全麻下非计划手术或经肛门拖出术后 90 天内再入院率均无显著差异。严重并发症（Clavien-Madadi≥3）方面无差异；然而，经集中治疗后，需要用抗生素治疗的高位肛门发育不良（HAEC）的比例增加（10.5-24.1%；p=0.018）。
HSCR 护理的集中化似乎不会延迟经肛门拖出术的时间，也不会降低全麻下非计划手术或经肛门拖出术后 90 天内的严重并发症、再入院率。HAEC 发生率的增加可能是由于对轻度 HAEC 的认识提高所致。
3 级。
