O1104: Nationwide Analysis of Rectosigmoid Hirschsprung Disease: Newborn or Staged Surgery?

Background: Hirschsprung Disease (HD) is one of the most common congenital intestinal disorders, occurring in approximately 1 in 5000 newborns. While treatment for HD often requires surgical resection, debate exists on whether patients should undergo immediate resection during their newborn hospitalization or undergo a staged procedure after an initial rectal biopsy. This study sought to compare postoperative outcomes and readmissions among newborns receiving immediate versus staged surgery for rectosigmoid HD.

Methods: The Nationwide Readmission Database was queried from 2016 to 2018 for newborns with HD. Patients were stratified into those who underwent surgical resection during their newborn hospitalization (immediate) versus during planned readmission (staged). Those who received no rectal biopsy during their newborn hospitalization and those with long-segment or total colonic HD were excluded. A propensity score-matched analysis (PSMA) of newborns with both types of procedures was constructed utilizing >50 covariates including demographics, comorbidities, perinatal diagnoses, and hospital characteristics. Demographics, hospital characteristics, and outcomes were analyzed using standard statistical tests. Results were weighted for national estimates

Results: There were 1,048 newborns with HD identified. Immediate repair was performed in the majority (56%) of newborns, with the remaining 44% undergoing a staged operation. For those receiving staged treatment, 67% had rectal biopsy alone and 33% received an ostomy during their newborn hospitalization. Forty-one percent of these patients underwent a pull-through procedure on readmission. Staged resection was associated with higher total hospitalization cost compared to newborn treatment ($56,642 [40,787-82,440] vs. 50,166 [38,171-70,444]), p=0.014.

Those undergoing staged treatment were more likely to have additional congenital anomalies (58% vs. 40%), most commonly cardiac (31% vs. 21%) or trisomy 21 (16% vs. 8%), all p< 0.001. After propensity score matching, patients were well matched for baseline characteristics (Table 1). Those undergoing staged treatment were more likely to have post-operative wound disruption and require home health care at discharge. Whereas index hospitalization costs were higher for newborn treatment, readmission costs were higher in the staged group. Patients receiving staged treatment were more likely to require unplanned readmission (40% vs. 23%) and these patients experienced more gastrointestinal complications (40% vs. 22%) on readmission, especially Hirschsprung-associated enterocolitis (30% vs. 17%), see Table 1.

Conclusion: Newborns receiving staged procedures for HD experience higher rates of unplanned readmission complications and incur higher hospitalization and healthcare utilization costs. This information should be utilized to defray healthcare utilization costs for newborns with HD.