Comparing 30-day outcomes between early versus delayed repair of anorectal malformations with perineal or rectovestibular fistulas: An analysis of the ACS NSQIP-Pediatric database.
J Pediatr Surg
; 56(5): 979-983, 2021 May.
Article
em En
| MEDLINE
| ID: mdl-33023749
ABSTRACT
BACKGROUND:
Anorectal malformations (ARMs) have a wide spectrum of presentation ranging from mild defects with perineal fistulas to more severe defects requiring complex management. A primary repair of ARMs with perineal or rectovestibular fistulas has been shown to have good outcomes. However, the timing of the reconstruction is still debated. The aim of this study is to investigate the safety of early versus delayed repair.METHODS:
This study was performed using data from the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) from 2012 to 2017. Patients who underwent repair of anorectal malformation with perineal or vestibular fistula were included in the study. Patients with associated diagnosis for Hirschsprung disease, cloaca, rectal prolapse or stenosis, bladder exstrophy, and tracheoesophageal fistula were excluded. 30-day postoperative outcomes included wound and nonwound complications, readmissions, and reoperations. Outcomes were compared by early (≤7â¯days of age) versus delayed repair (6â¯weeks to 8â¯months).RESULTS:
A total of 291 patients were included, with 66 in the early and 231 in the delayed group. Patients in the early group were more likely to be male (68.2% vs 31.8%; pâ¯<â¯0.01) and have cardiac risk factors (71.2% vs 49.4%, pâ¯<â¯0.01). The mean operative time was significantly shorter in the early group (90.1 vs 129.6â¯min; pâ¯<â¯0.01). 30-day complications were not statistically significant between the two groups (pâ¯=â¯0.76). After multivariate analysis, timing of repair did not affect 30-day complications (pâ¯=â¯0.15).CONCLUSION:
Our study shows that early repair of low anorectal malformations with a perineal or vestibular fistula appears to be associated with no increase in risk of postoperative complications as compared to delayed repair. At present, the decision remains dependent on the surgeon's experience and judgment. LEVEL OF EVIDENCE Level III. Retrospective comparative study.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Fístula Retal
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Malformações Anorretais
Tipo de estudo:
Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Child
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Female
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Humans
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Male
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Newborn
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article