Inpatient management of Hirschsprung’s associated enterocolitis treatment: the benefits of standardized care
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In brief
In brief
Standardized treatment algorithm for Hirschsprung-associated enterocolitis (HAEC) significantly reduced hospital length of stay from 7 to 2 days and eliminated routine TPN use without increasing readmissions. Retrospective study of 62 HAEC episodes demonstrates clinical pathways can improve efficiency while maintaining quality care.
Written by the GCMD Library team from the article.
Abstract
Introduction
Patients with Hirschsprung's disease (HSCR) remain at risk of developing Hirschsprung-associated enterocolitis (HAEC) after surgical intervention. As inpatient management remains variable, our institution implemented an algorithm directed at standardizing treatment practices. This study aimed to compare the outcomes of patients pre- and post-algorithm.
Methods
A retrospective review of patients admitted for HAEC was performed; January 2017–June 2018 encompassed the pre-implementation period, and October 2018–October 2019 was the post-implementation period. Demographics and outcomes were compared between the two groups.
Results
Sixty-two episodes of HAEC occurred in 27 patients during the entire study period. Sixteen patients (59%) had more than one episode. The most common levels of the transition zone were the rectosigmoid (50%) and descending colon (27%). Following algorithm implementation, the median length of stay (2 vs. 7 days, p < 0.001), TPN duration (0 vs. 5.5 days, p < 0.001), and days to full enteral diet (6 days vs. 2 days, p < 0.001) decreased significantly. Readmission rates for recurrent enterocolitis were similar pre- and post-algorithm implementation.
Conclusion
The use of a standardized algorithm significantly decreases the length of stay and duration of intravenous antibiotic administration without increasing readmission rates, while still providing appropriate treatment for HAEC.
Level of evidence
III level.
Type of study
Retrospective comparative study.