Does Delayed Diagnosis of Hirschsprung Disease (HD) Impact Post-op Outcomes? | Multi-center | Retrospective review | Jan 2017 - Mar 2023 | 679 patients in 4 groups: | neonates <29 days | infants 29 days-12 months | toddler 1 year-5 years | child >5 years | 69% were diagnosed in the neonatal period | Age at diagnosis was not associated with differences in 30-day complication rates or need for pull-through revision. | Older age at diagnosis | Increased likelihood of fecal diversion after pull-through (P < 0.001) | Increased need for intervention for constipation/incontinence (P < 0.001) | Conclusion: Delayed diagnosis of HD doesn't impact 30-day outcomes or revision surgery rates but is associated w/ a higher need for fecal diversion after pull-through. | https://pubmed.ncbi.nlm.nih.gov/38677965/ | Source: Ullrich S et. al. | Colorectal Center, Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, USA | @EmGooteeMD | @StayCurrentMD | Cincinnati Children's | Journal of Pediatric Surgery
Does Delayed Diagnosis of Hirschsprung Disease Impact Post-operative and Functional Outcomes?
Infographic · Aug 2024 · 1 min read
In brief
In brief
Multi-center study of 679 HD patients found that delayed diagnosis beyond the neonatal period does not increase 30-day complications or revision rates, but significantly increases the need for post-operative fecal diversion (10% in neonates vs 28% in children >5 years) and interventions for constipation or incontinence.
- Delayed HD diagnosis beyond neonatal period does not increase 30-day complications or revision surgery rates after pull-through.
- Children diagnosed after age 1 year have 2-3× higher rates of requiring fecal diversion post-operatively (26-28% vs 10% in neonates).
- Older age at diagnosis correlates with increased need for constipation/incontinence interventions (78% toddlers vs 56% neonates).
- Most HD patients (69%) are still diagnosed in neonatal period, but delayed presentations require different postoperative management.
- Early diagnosis may reduce long-term functional complications, though immediate surgical outcomes remain comparable across age groups.
Written by the GCMD Library team from the infographic.
The infographic uses a teal and yellow color scheme with cartoon illustrations of children at different ages. A hospital building illustration appears on the left, and a digestive system diagram is shown in the middle section. Key statistics are highlighted in large text, with the conclusion emphasized in a yellow banner at the bottom.
Sarah Ullrich, Kelly Austin, Jeffrey R Avansino, Andrea Badillo, Casey M Calkins, Rachel C Crady, Megan M Durham, Megan K Fuller, Ankur Rana, Ron W Reeder, Rebecca M Rentea, Michael D Rollins, Payam Saadai, K Elizabeth Speck, Richard J Wood, Kathleen van Leeuwen, Jason S Frischer; Pediatric Colorectal and Pelvic Learning Consortium
Background: Hirschsprung Disease (HD) is a rare cause of functional bowel obstruction in children. Patients are typically diagnosed in the neonatal period and undergo pull-through (PT) soon after diagnosis. The optimal management and post-operative outcomes of children who present in a delayed fashion are unknown.
Methods: A multi-center retrospective review of children with HD was performed at participating Pediatric Colorectal and Pelvic Learning Consortium sites. Children were stratified by age at diagnosis (neonates <29 days; infants 29 days–12 months; toddler 1 year–5 years and child >5 years).
Results: 679 patients with HD from 14 sites were included; Most (69%) were diagnosed in the neonatal period. Age at diagnosis was not associated with differences in 30-day complication rates or need for PT revision. Older age at diagnosis was associated with a greater likelihood of undergoing fecal diversion after PT (neonate 10%, infant 12%, toddler 26%, child 28%, P < 0.001) and a greater need for intervention for constipation or incontinence postoperatively (neonate 56%, infant 62%, toddler 78%, child 69%, P < 0.001).
Conclusion: Delayed diagnosis of HD does not impact 30-day post-operative outcomes or need for revision surgery but, delayed diagnosis is associated with increased need for fecal diversion after pull-through.