Relationships Between Hospital and Surgeon Operative Volumes and Surgical Outcomes in Hirschsprung's Disease

J Surg Res. 2021 Jan:257:379-388. doi: 10.1016/j.jss.2020.08.014. Epub 2020 Sep 4.


Background: The impact of surgical volume on outcomes in Hirschsprung's disease (HD) remains uninvestigated. We aimed to determine whether higher surgeon and hospital-level HD operative volumes are associated with improved surgical outcomes following primary surgery for neonatal HD.

Materials and methods: Neonates who underwent either an ostomy or pull-through (PT) procedure for HD before 60 d of life and a PT procedure by age 1 y were identified in the Pediatric Health Information System (PHIS). Index admissions from January 2000 to September 2012 across 41 tertiary childrens hospitals were included. Surgeon and hospital-level HD operative volume were defined as the average annual number of PT procedures performed for HD in the 2 y preceding each included case. We examined the relationship between operative volumes and all-cause readmission, readmission for Hirschsprung's associated enterocolitis (HAEC), and rates of reoperation within 30 d and 2 y.

Results: A total of 1268 infants were included. There were 218 patients (17.2%) readmitted to the hospital within 30 d and 540 (42.6%) within 2 y. A total of 119 patients (9.4%) had HAEC-related readmission within 30 d, and 271 (21.4%) had HAEC-related readmission within 2 y. A total of 57 patients (4.5%) had a reoperation within 30 d and 129 (10.2%) within 2 y. In risk-adjusted analyses, there were no significant associations between either surgeon or hospital HD operative volumes and readmission/reoperation rates within 30 d or 2 y.

Conclusions: Neither surgeon nor hospital PT volumes were significantly associated with readmission or reoperation rates for infants with Hirschsprung's disease. Future work is needed to evaluate whether operative volumes are associated with functional outcomes following PT for HD.

Keywords: Enterocolitis; Hirschsprung’s disease; Neonatology; Pediatric surgery; Pull-through procedure; Volume-outcome.

Publication types

  • Multicenter Study

MeSH terms

  • Digestive System Surgical Procedures / statistics & numerical data*
  • Female
  • Hirschsprung Disease / surgery*
  • Hospitals, High-Volume / statistics & numerical data*
  • Hospitals, Low-Volume / statistics & numerical data*
  • Humans
  • Infant, Newborn
  • Male
  • Retrospective Studies
  • Surgeons / statistics & numerical data*
  • Treatment Outcome