Nationwide outcomes of newborns with rectosigmoid versus long-segment Hirschsprung disease

• Published in: Journal of pediatric surgery Vol. 58; no. 5; pp. 849 - 855
• Main Authors: Huerta, Carlos Theodore, Ramsey, Walter A., Davis, Jenna K., Saberi, Rebecca A., Gilna, Gareth P., Parreco, Joshua P., Sola, Juan E., Perez, Eduardo A., Thorson, Chad M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2023
• Subjects: Hirschsprung disease; Hirschsprung Disease - complications; Hirschsprung Disease - epidemiology; Hirschsprung Disease - surgery; Humans; Infant; Infant, Newborn; Long segment Hirschsprung; Newborns; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Rectosigmoid Hirschsprung disease; Rectum - surgery; Retrospective Studies; LSHD; RDS; NRD; GI; OR; Long segment Hirschsprung; DH; Rectosigmoid Hirschsprung disease; FTT; IQR; NEC; GU; QOL; Newborns; SD; PSMA; RBC; Hirschsprung disease; HAEC; GA; HD
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2023.01.001

Hirschsprung Disease (HD) is a common congenital intestinal disorder. While aganglionosis most commonly affects the rectosigmoid colon (rectosigmoid HD), outcomes for patients in which aganglionosis extends to more proximal segments (long-segment HD) remain understudied. This study sought to compare postoperative outcomes among newborns with rectosigmoid and long-segment HD.
The Nationwide Readmission Database was queried from 2016 to 2018 for newborns with HD. Newborns were stratified into those with rectosigmoid or long-segment HD. Those who received no rectal biopsy or pull-through procedure during their newborn hospitalization were excluded. A propensity score-matched analysis (PSMA) of newborns with either type of HD was constructed utilizing 17 covariates including demographics, comorbidities, and congenital-perinatal conditions.
There were 1280 newborns identified with HD (82% rectosigmoid HD, 18% long-segment HD). Patients with rectosigmoid HD had higher rates of laparoscopic resections (35% vs. 12%) and less frequently received a concomitant ostomy (14% vs. 84%), both p < 0.001. Patients with long-segment HD were more likely to have a delayed diagnosis (12% vs. 5%) and require multiple bowel operations (19% vs. 4%), both p < 0.001. They experienced higher rates of complications, including small bowel obstructions (10% vs. 1%), infections (45% vs. 20%), and Hirschsprung-associated enterocolitis (11% vs. 5%), all p < 0.001. After PSMA, newborns with long-segment HD were found to have a longer length of stay and higher hospitalization costs.
Newborns with long-segment HD experience significant delays in diagnosis, surgery, and complications compared to those with rectosigmoid HD. This information should be utilized to improve healthcare delivery for this patient population.
Retrospective comparative study.
III.
•Aganglionosis in Hirschsprung Disease (HD) most commonly affects the rectosigmoid colon. Outcomes for patients with long-segment HD remain understudied.•Newborns with long-segment HD (LSDH) experience delays in diagnosis and surgery compared to those with rectosigmoid HD.•Newborns with LSHD experience higher complications and utilize more healthcare resources than those with rectosigmoid HD.