Inpatient management of Hirschsprung's associated enterocolitis treatment: the benefits of standardized care.

Creator(s)

Wendy Jo Svetanoff, Children's Mercy HospitalFollow
Charlene Dekonenko, Children's Mercy HospitalFollow
Obiyo Osuchukwu, Children's Mercy Hospital
Tolulope A. Oyetunji MD MPH, Children's Mercy HospitalFollow
Pablo Aguayo, Children's Mercy HospitalFollow
Jason D. Fraser, Children's Mercy HospitalFollow
David Juang, Children's Mercy HospitalFollow
Charles L. Snyder, Children's Mercy HospitalFollow
Richard J. Hendrickson, Children's Mercy HospitalFollow
Shawn D. St Peter, Children's Mercy HospitalFollow
Rebecca M. Rentea, Children's Mercy HospitalFollow

Document Type

Article

Publication Date

12-2020

Identifier

DOI: 10.1007/s00383-020-04747-4

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.

Journal Title

Pediatric surgery international

Volume

36

Issue

12

First Page

1413

Last Page

1421

Keywords

Colorectal; Enterocolitis; Hirschsprung disease; Pediatric

Recommended Citation

Svetanoff WJ, Dekonenko C, Osuchukwu O, et al. Inpatient management of Hirschsprung's associated enterocolitis treatment: the benefits of standardized care. Pediatr Surg Int. 2020;36(12):1413-1421. doi:10.1007/s00383-020-04747-4