Age and Weight Stratified Outcomes of Single Stage Endorectal Pull-through Procedures for Hirschsprung's Disease in Children: Analysis of NSQIP-P Data.

Background: We aimed to analyze the effect of age and weight on 30-day outcomes of single-stage endorectal pull tthrough (ERPT) procedures for Hirschsprung's Disease (HD) using the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database to identify an optimal time for surgery.

Methods: We queried NSQIP-P for children <2 years with HD who underwent ERPT between 2016-2021 and did not have a preoperative stoma. Patients were stratified by age (<3 months, 3-6 months and >6 months) and weight (<4 kg, 4-8 kg, and >8 kg) at the time of surgery. The primary outcome measure was major adverse outcomes, and the secondary outcomes were 30-day unplanned readmission and reoperation. Multivariable logistic regression was conducted to analyze the association between age and weight and each outcome.

Results: A total of 1002 patients were included with a median age of 31 days (IQR: 10-106 days). Patients were stratified by age (n = 702, 70.1 %; n = 158, 15.8 %; n = 142, 14.2 % respectively from youngest to oldest) and weight (n = 472, 47.1 %; n = 421, 42.0 %; n = 109, 10.9 % respectively from lowest to highest weight) groups. On multivariable analysis, age>6 months and weight>8 kg were independently associated with a higher rate of major complications (aOR = 2.741, 95 % C.I. = 1.234-5.880 and aOR = 4.627, 95 % C.I. = 1.761-11.775 respectively). Conversely, being in the highest age (aOR = 0.359, 95 % C.I. = 0.176-0.699) and weight brackets (aOR = 0.396, 95 % C.I. = 0.171-0.801) independently predicted lower 30-day readmission rates.

Conclusion: Earlier single-stage ERPT for HD was found to be associated with lower complication rates in a select group of patients but may result in increased rates of readmissions and hospital resource utilization.

Level of evidence: Level III evidence.

Type of study: Retrospective cohort study.