Hirschsprung-associated enterocolitis in children treated at US children's hospitals.

ABSTRACT

BACKGROUND: The incidence of and risk factors for Hirschsprung's-associated enterocolitis (HAEC) following pull-through have been limited to single institutions studies. We characterized the incidence of, risk factors for, and consequences of post-operative HAEC. METHODS: We identified children with Hirschsprung's Disease (HD) at US Children's Hospitals from 2007 to 2017 with and an associated pull-through operation at less than 1 year of age. HAEC readmissions were identified using ICD9/10 Diagnosis Codes and antibiotic administration. Hierarchical logistic regression models were developed for the risk factors for HAEC after pull-through and effects of recurrent HAEC on HD-related reoperations. RESULTS: We identified 2030 children with HD, and 138 (7%) who had two or more readmissions related to HAEC. The frequency of recurrent HAEC by hospital ranged from 0 to 33%. Pre-operative HAEC, history of central nervous system infection, and congenital neurologic anomalies were associated with increased risk of recurrent HAEC. Recurrent HAEC was associated with HD-specific re-operation (OR 5.2, CI 3.3-8.1, p < 0.001); however, it was not associated with risk of in-hospital mortality (OR 3.3, CI 0.88-12.1, p = 0.08). CONCLUSIONS: HAEC following pull-through occurs in a large proportion of infants with HD and predicts reoperation. Multicenter studies are needed to develop prediction models and treatment protocols for HAEC. LEVEL OF EVIDENCE II TYPE OF STUDY Retrospective cohort study.