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

Ahmer Irfan; Andrew Hu; Laura Y Martin; Eric B Jelin; Alejandro V Garcia; Tim Jancelewicz; Emily Boss; Isam W Nasr; Daniel S Rhee

doi:10.1016/j.jpedsurg.2020.09.002

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. 2021 May;56(5):979-983. doi: 10.1016/j.jpedsurg.2020.09.002. Epub 2020 Sep 16.

Authors

Ahmer Irfan¹, Andrew Hu², Laura Y Martin¹, Eric B Jelin¹, Alejandro V Garcia¹, Tim Jancelewicz³, Emily Boss⁴, Isam W Nasr¹, Daniel S Rhee⁵

Affiliations

¹ Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
² Department of Surgery, Northwestern University, Chicago, IL, USA.
³ Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
⁴ Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, MD. USA.
⁵ Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: drhee1@jhmi.edu.

PMID: 33023749
DOI: 10.1016/j.jpedsurg.2020.09.002

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 (≤7 days of age) versus delayed repair (6 weeks to 8 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%; p < 0.01) and have cardiac risk factors (71.2% vs 49.4%, p < 0.01). The mean operative time was significantly shorter in the early group (90.1 vs 129.6 min; p < 0.01). 30-day complications were not statistically significant between the two groups (p = 0.76). After multivariate analysis, timing of repair did not affect 30-day complications (p = 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.

Keywords: Anorectal malformation; NSQIP-Pediatric; Neonatal surgery.

MeSH terms

Anal Canal / surgery
Anorectal Malformations* / surgery
Child
Female
Humans
Infant, Newborn
Male
Perineum / surgery
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Rectal Fistula* / surgery
Rectum / surgery
Retrospective Studies