Prematurity Associated With Increased Complications and Reoperation After Pull-Through in Hirschsprung Disease.

INTRODUCTION

Hirschsprung disease (HD) is a congenital disorder of the enteric nervous system, requiring definitive surgical treatment through pull-through procedures. While prematurity generally increases postoperative risk, it remains unclear whether prematurity is associated with worse short-term surgical outcomes in HD patients. This study investigates the association between prematurity and postoperative complications and reoperation rates following pull-through procedures in HD.

METHODS

This retrospective cohort study utilized the National Surgical Quality Improvement Program-Pediatric database, identifying HD patients aged 0-18 ys who underwent pull-through surgery from 2016 to 2022. Patients were divided into two groups: preterm (born <37 wk gestation) and full-term (born ≥37 wk gestation). Outcomes of interest included 30-d postoperative complication rates and related reoperations. Univariate and multivariate logistic regression models assessed the association of prematurity with outcomes.

RESULTS

2603 patients were included, with 296 (11.4%) born preterm. 76.5% were males, and median age at surgery was 4 mos (interquartile range: 0.7-13.6). Overall, the rate of developing any complication was 17.6%. 9.1% of patients had an unplanned reoperation, including 7.4% related to the initial surgery. Premature infants had higher rates of developing any complication (24.3% versus 16.7%; P = 0.001) and related reoperations (10.5% versus 7.0%; P = 0.030) within 30 ds of undergoing pull-through surgery. Multivariate analysis and subsequent subanalysis across age categories confirmed prematurity as an independent predictor of overall complications (adjusted odds ratio: 1.76; 95% confidence interval: 1.23-2.53) and related reoperations (adjusted odds ratio: 2.12; 95% confidence interval: 1.30-3.46) in children less than 1 y of age.

CONCLUSIONS

Premature birth is associated with increased complications and related reoperations following pull-through surgery for HD. These findings suggest that prematurity should be considered when managing postoperative care in this population.