Child Opportunity Index is Not Associated With Cleanliness in Patients With Anorectal Malformations Treated at Pediatric Colorectal Centers: A Multi-Institutional Study.

Document Type

Article

Publication Date

4-2025

Identifier

DOI: 10.1016/j.jpedsurg.2024.162149

Abstract

BACKGROUND: Individually collected social determinants of health (SDOH) have been associated with negative outcomes in children with anorectal malformations (ARMs). Our aim was to assess whether the Child Opportunity Index (COI) is associated with bowel management strategy and fecal cleanliness in patients with ARM managed at specialized pediatric colorectal centers. We hypothesized that children from low COI would have lower rates of cleanliness.

METHODS: A multi-institutional retrospective review evaluated children ≥4 years old with ARM treated at centers participating in the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC), excluding patients with ostomies. The primary exposure was COI, obtained by ZIP code. The primary outcome was fecal cleanliness, defined as ≤1 weekly stool accident. Additional variables evaluated included demographics, ARM severity, bowel management type, medical comorbidities, and complications in those undergoing antegrade continence enema procedures. COI groups were compared for trend (p-value ≤0.05 as significant).

RESULTS: The cohort included 550 patients, most (75.1%) residing in moderate, high, or very high opportunity areas. There were no differences in ARM severity between COI groups. Stratified by age, there were no differences in fecal cleanliness (p = 0.788) or bowel management strategy (p = 0.224) by COI. There were few overall complications from ACE placement (12.3%), but ACE complications were more common in children from low-opportunity areas (22.2% vs 2.9%; p = 0.01).

CONCLUSION: Contrary to hypothesized, children with anorectal malformations managed at tertiary institutions within PCPLC do not differ by COI in bowel management strategy or fecal cleanliness outcome. Further investigation into individual disparities may be more important in these patients.

LEVEL OF EVIDENCE: III = retrospective comparative study.

Journal Title

Journal of pediatric surgery

Volume

60

Issue

4

First Page

162149

Last Page

162149

MeSH Keywords

Humans; Anorectal Malformations; Retrospective Studies; Male; Female; Child, Preschool; Child; Enema; Fecal Incontinence; Adolescent

PubMed ID

39919338

Keywords

Antegrade continence enemas; Bowel management programs; Cloaca; Social determinants of health

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