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National centralization of Hirschsprung’s disease in Sweden : a comparison of postoperative outcome

Söderström, Linnea ; Graneli, Christina LU ; Rossi, Daniel ; Hagelsteen, Kristine LU orcid ; Gunnarsdottir, Anna ; Oddsberg, Jenny ; Svensson, Pär Johan ; Borg, Helena ; Bräutigam, Matilda and Gustafson, Elisabet , et al. (2024) In Pediatric Surgery International 40(1).
Abstract

Background: In Sweden, surgical treatment of Hirschsprung’s disease (HSCR) was centralized from four to two pediatric surgery centers 1st of July 2018. In adults, centralization of surgical care for complex or rare diseases seems to improve quality of care. There is little evidence supporting centralization of pediatric surgical care. The aim of this study was to assess surgical management and postoperative outcome in HSCR patients following centralization of care. Methods: This study retrospectively analyzed data of patients with HSCR that had undergone pull-through at a pediatric surgery center in Sweden from 1st of July 2013 to 30th of June 2023. Patients managed from 1st of July 2013 to 30th of June 2018 (before centralization) were... (More)

Background: In Sweden, surgical treatment of Hirschsprung’s disease (HSCR) was centralized from four to two pediatric surgery centers 1st of July 2018. In adults, centralization of surgical care for complex or rare diseases seems to improve quality of care. There is little evidence supporting centralization of pediatric surgical care. The aim of this study was to assess surgical management and postoperative outcome in HSCR patients following centralization of care. Methods: This study retrospectively analyzed data of patients with HSCR that had undergone pull-through at a pediatric surgery center in Sweden from 1st of July 2013 to 30th of June 2023. Patients managed from 1st of July 2013 to 30th of June 2018 (before centralization) were compared with patients managed from 1st of July 2018 to 30th of June 2023 (after centralization) regarding surgical treatment, unplanned procedures under general anesthesia or readmissions up to 90 days after pull-through as well as complications classified according to Clavien–Madadi up to 30 days after pull-through. Results: In the 5-year period prior to centralization, 114 individuals from 4 treating centers were included and compared to 83 patients from 2 treating centers in the second period. There was no difference regarding age at pull-through or proportion of patients with a stoma prior to pull-through. An increase of laparoscopically assisted endorectal pull-through (8.8% to 39.8%) was observed (p < 0.001). No significant differences were seen in postoperative hospital stay, unplanned procedures under general anesthesia, or readmissions up to 90 days after pull-through. There was no difference in severe complications (Clavien–Madadi ≥ 3); however, HAEC treated with antibiotics increased following centralization (10.5–24.1%; p = 0.018). Conclusion: Centralization of care for HSCR does not seem to delay time to pull-through nor reduce severe complications, unplanned procedures under general anesthesia or readmissions up to 90 days after pull-through. The increased HAEC rate may be due to increased awareness of mild HAEC. Level of evidence: Level III.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
Centralization, Hirschsprung’s disease, National specialized medical care, Postoperative, Surgical outcome
in
Pediatric Surgery International
volume
40
issue
1
article number
265
publisher
Springer
external identifiers
  • scopus:85205828396
  • pmid:39369074
ISSN
0179-0358
DOI
10.1007/s00383-024-05842-6
language
English
LU publication?
yes
id
608a7ead-2f99-474d-9773-042efff6c3fc
date added to LUP
2024-11-27 14:23:10
date last changed
2025-07-10 09:07:19
@article{608a7ead-2f99-474d-9773-042efff6c3fc,
  abstract     = {{<p>Background: In Sweden, surgical treatment of Hirschsprung’s disease (HSCR) was centralized from four to two pediatric surgery centers 1st of July 2018. In adults, centralization of surgical care for complex or rare diseases seems to improve quality of care. There is little evidence supporting centralization of pediatric surgical care. The aim of this study was to assess surgical management and postoperative outcome in HSCR patients following centralization of care. Methods: This study retrospectively analyzed data of patients with HSCR that had undergone pull-through at a pediatric surgery center in Sweden from 1st of July 2013 to 30th of June 2023. Patients managed from 1st of July 2013 to 30th of June 2018 (before centralization) were compared with patients managed from 1st of July 2018 to 30th of June 2023 (after centralization) regarding surgical treatment, unplanned procedures under general anesthesia or readmissions up to 90 days after pull-through as well as complications classified according to Clavien–Madadi up to 30 days after pull-through. Results: In the 5-year period prior to centralization, 114 individuals from 4 treating centers were included and compared to 83 patients from 2 treating centers in the second period. There was no difference regarding age at pull-through or proportion of patients with a stoma prior to pull-through. An increase of laparoscopically assisted endorectal pull-through (8.8% to 39.8%) was observed (p &lt; 0.001). No significant differences were seen in postoperative hospital stay, unplanned procedures under general anesthesia, or readmissions up to 90 days after pull-through. There was no difference in severe complications (Clavien–Madadi ≥ 3); however, HAEC treated with antibiotics increased following centralization (10.5–24.1%; p = 0.018). Conclusion: Centralization of care for HSCR does not seem to delay time to pull-through nor reduce severe complications, unplanned procedures under general anesthesia or readmissions up to 90 days after pull-through. The increased HAEC rate may be due to increased awareness of mild HAEC. Level of evidence: Level III.</p>}},
  author       = {{Söderström, Linnea and Graneli, Christina and Rossi, Daniel and Hagelsteen, Kristine and Gunnarsdottir, Anna and Oddsberg, Jenny and Svensson, Pär Johan and Borg, Helena and Bräutigam, Matilda and Gustafson, Elisabet and Löf Granström, Anna and Stenström, Pernilla and Wester, Tomas}},
  issn         = {{0179-0358}},
  keywords     = {{Centralization; Hirschsprung’s disease; National specialized medical care; Postoperative; Surgical outcome}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{Springer}},
  series       = {{Pediatric Surgery International}},
  title        = {{National centralization of Hirschsprung’s disease in Sweden : a comparison of postoperative outcome}},
  url          = {{http://dx.doi.org/10.1007/s00383-024-05842-6}},
  doi          = {{10.1007/s00383-024-05842-6}},
  volume       = {{40}},
  year         = {{2024}},
}