ENTEROCOLITIS AFTER THE SURGICAL-TREATMENT OF HIRSCHSPRUNGS-DISEASE -RISK-FACTORS AND FINANCIAL IMPACT

Background/Purpose: Enterocolitis (EC) represents a serious complicati on after the surgical correction of Hirschsprung's disease (HD), Altho ugh previous studies have identified risk factors associated with the development of this complication before definitive repair, the factors leading to EC after pull-through have not been examined. This study w as therefore designed to determine risk factors for the development of post-pull-through EC. Methods: Patients with HD treated from 1991 thr ough 1996 at the Hospital for Sick Children in Toronto, Canada were as sessed. Risk factors were examined in three areas: patient factors (ge nder, age at diagnosis, age and weight at pull-through), technical fac tors (type of repair, number of stages, location of transition zone, p revious EC), and mechanical factors. Results: In 105 consecutive patie nts, the incidence of postoperative EC was 32%. There was no mortality . The risk of postoperative EC was significantly increased by mechanic al factors related to anastomotic complications (relative risk, 2.8) a nd intestinal obstruction (relative risk, 3.5). This finding was not a ttributable to the general occurrence of any postoperative complicatio n because the incidence of postoperative complications was equally dis tributed in patients with and without EC, The presence of EC significa ntly increased the number of hospital admissions, mean length of stay, and total treatment cost, Conclusion: These findings suggest the use of measures to decrease mechanical obstruction so as to decrease the i ncidence and impact of this potentially devastating complication. Copy right (C) 1998 by W.B. Saunders Company.