Delay in Operation for Hirschsprung Disease Decreases Length of Stay: a 5 Year Analysis of NSQIP Data
*Mollie R. Freedman-Weiss, *Alexander S. Chiu, Michael G. Caty, *Daniel G. Solomon
Yale School of Medicine, New Haven, CT
Objective: For appropriately selected patients with Hirschsprung Disease (HD), single-stage primary pull through obviates the need for a second stage ostomy takedown. The correct timing of pull-through is controversial, and can be performed at time of diagnosis or electively in stable infants stooling via rectal irrigation after a period of growth. We sought to compare outcomes of pull-through done in the first 30 days of life to 31-120 days.
Design: Retrospective review of NSQIP-Peds database from 2012-2016
Setting: ACS NSQIP-Peds affiliated Hospitals
Patients: Infants <120 days old, >36 weeks gestational age, with HD, without prior ostomy or major comorbidities, who underwent primary pull-through
Main Outcome Measure: Postoperative length of stay (LOS), readmission rate, cumulative postoperative complications (infectious, reoperation, sepsis, etc)
Results: Of 282 patients, 182 (65%) underwent pull-through at <31 days and 100 (35%) between 31-120 days. Postoperative LOS in <31 day group was 8.2 days (SD- 8.3) versus 4.3 days (SD-5.5) in 31-120 day group (p<0.001). Linear regression adjusting for patient factors demonstrated that pull-through at 31-120 days predicted lower postoperative and total LOS [postop: -3.1 days (CI, -5.6 to -0.5); total: -4.6 days (CI, -8.1 to -1.2)]. Neither readmission nor cumulative complication rates significantly differed between age groups (readmission: 15.6% vs 13% p=0.51; complication: 5.5% vs 10% p=0.16 for <31 day vs 31-120 days respectively).
Conclusion: For otherwise healthy infants with HD, delaying pull through until the second month of life is associated with total and postoperative LOS reductions of 3 and 5 days respectively—without increased readmissions or complications. This finding may guide surgeons’ decisions on timing of pull-through and encourage discharging infants with HD home prior to operation.