Selesner Leigh, Bigej Ryan, Alturky Sara, Vaughn Cortnie, Gause Colin, Krishnaswami Sanjay, Fialkowski Elizabeth
Depart of Surgery, Oregon Health & Science University, Portland, OR, USA.
School of Medicine, Oregon Health & Science University, Portland, OR, USA.
Pediatr Surg Int. 2025 May 29;41(1):150. doi: 10.1007/s00383-025-06051-5.
A standardized anorectal malformation (ARM) perioperative protocol was implemented across two pediatric tertiary hospitals. The protocol addressed antibiotic duration, feeding advancement, VACTERL workup, and wound management. We aim to evaluate complications, length of stay (LOS), and protocol compliance.
Introduced in June 2020, data from a 24-month protocol cohort (after a 6-month transition) were compared to a 24-month control cohort. Outcomes included demographics, compliance, complications and LOS.
Forty-five patients were included (control: 26, protocol: 19). Most were diagnosed with rectoperineal fistula (53%), 42% had significant cardiac disease, and 44% underwent prior colostomy. VACTERL workup was completed in 89%. Thirty-five patients underwent posterior sagittal anorectoplasty, and 10 cutback anoplasty. Median postoperative LOS was unchanged (control: 2 days; protocol: 2 days, p=0.80). Total LOS showed no difference (control: 3 days, protocol: 2 days, p = 0.51). No wound infections occurred. Wound dehiscence occurred in 1 control and 2 protocol patients (p=0.57). Compliance was 53% with deviations attributed to early diet initiation (n=4), incomplete VACTERL workup (n=2), and wound care (n=2).
A standardized ARM perioperative protocol is feasible across institutions. It maintained excellent outcomes, including short LOS and few complications, though the small sample limited statistical power.
在两家儿科三级医院实施标准化的肛门直肠畸形（ARM）围手术期方案。该方案涉及抗生素使用时长、喂养进展、VACTERL检查以及伤口处理。我们旨在评估并发症、住院时长（LOS）和方案依从性。
该方案于2020年6月引入，将24个月方案队列（经过6个月过渡期后）的数据与24个月对照队列的数据进行比较。结果包括人口统计学数据、依从性、并发症和住院时长。
共纳入45例患者（对照组：26例，方案组：19例）。大多数患者被诊断为直肠会阴瘘（53%），42%患有严重心脏病，44%曾接受过结肠造口术。89%的患者完成了VACTERL检查。35例患者接受了后矢状位肛门直肠成形术，10例接受了缩减式肛门成形术。术后中位住院时长无变化（对照组：2天；方案组：2天，p = 0.80）。总住院时长无差异（对照组：3天，方案组：2天，p = 0.51）。未发生伤口感染。1例对照组患者和2例方案组患者发生伤口裂开（p = 0.57）。依从性为53%，偏差原因包括过早开始饮食（n = 4）、VACTERL检查不完整（n = 2）以及伤口护理（n = 2）。
标准化的ARM围手术期方案在不同机构间是可行的。尽管样本量小限制了统计效力，但该方案仍保持了良好的结果，包括住院时长短和并发症少。
