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The impact of perioperative care on complications and short term outcome in ARM type rectovestibular fistula : An ARM-Net consortium study

, ; van der Steeg, H. J.J.; van Rooij, I. A.L.M.; Iacobelli, B. D.; Sloots, C. E.J.; Leva, E.; Broens, P.; Fascetti Leon, F.; Makedonsky, I. and Schmiedeke, E., et al. (2019) In Journal of Pediatric Surgery
Abstract

Background: The impact of perioperative care interventions on postreconstructive complications and short-term colorectal outcome in patients with anorectal malformation (ARM) type rectovestibular fistula is unknown. Methods: An ARM-Net consortium multicenter retrospective cohort study was performed including 165 patients with a rectovestibular fistula. Patient characteristics, perioperative care interventions, timing of reconstruction, postreconstructive complications and the colorectal outcome at one year of follow-up were registered. Results: Overall complications were seen in 26.8% of the patients, of which 41% were regarded major. Differences in presence of enterostomy, timing of reconstruction, mechanical bowel preparation,... (More)

Background: The impact of perioperative care interventions on postreconstructive complications and short-term colorectal outcome in patients with anorectal malformation (ARM) type rectovestibular fistula is unknown. Methods: An ARM-Net consortium multicenter retrospective cohort study was performed including 165 patients with a rectovestibular fistula. Patient characteristics, perioperative care interventions, timing of reconstruction, postreconstructive complications and the colorectal outcome at one year of follow-up were registered. Results: Overall complications were seen in 26.8% of the patients, of which 41% were regarded major. Differences in presence of enterostomy, timing of reconstruction, mechanical bowel preparation, antibiotic prophylaxis and postoperative feeding regimen had no impact on the occurrence of overall complications. However, mechanical bowel preparation, antibiotic prophylaxis ≥ 48 h and postoperative nil by mouth showed a significant reduction in major complications. The lowest rate of major complications was found in the group having these three interventions combined (5.9%). Multivariate analyses did not show independent significant results of any of the perioperative care interventions owing to center-specific combinations. At one year follow-up, half of the patients experienced constipation and this was significantly higher among those with preoperative mechanical bowel preparation. Conclusions: Differences in perioperative care interventions do not seem to impact the incidence of overall complications in a large cohort of European rectovestibular fistula-patients. Mechanical bowel preparation, antibiotic prophylaxis ≥ 48 h, and postoperative nil by mouth showed the least major complications. Independency could not be established owing to center-specific combinations of interventions. Type of study: Treatment study. Level of evidence: III

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epub
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keywords
Anorectal malformation (ARM), Antibiotic prophylaxis, Complications, Mechanical bowel preparation, Perioperative care, Postoperative feeding regimen
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Journal of Pediatric Surgery
publisher
Elsevier
external identifiers
  • scopus:85063886929
ISSN
0022-3468
DOI
10.1016/j.jpedsurg.2019.03.008
language
English
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yes
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3c053936-5e0a-432f-b766-a4a44cc15bc0
date added to LUP
2019-04-23 14:32:00
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2019-05-14 04:53:55
@article{3c053936-5e0a-432f-b766-a4a44cc15bc0,
  abstract     = {<p>Background: The impact of perioperative care interventions on postreconstructive complications and short-term colorectal outcome in patients with anorectal malformation (ARM) type rectovestibular fistula is unknown. Methods: An ARM-Net consortium multicenter retrospective cohort study was performed including 165 patients with a rectovestibular fistula. Patient characteristics, perioperative care interventions, timing of reconstruction, postreconstructive complications and the colorectal outcome at one year of follow-up were registered. Results: Overall complications were seen in 26.8% of the patients, of which 41% were regarded major. Differences in presence of enterostomy, timing of reconstruction, mechanical bowel preparation, antibiotic prophylaxis and postoperative feeding regimen had no impact on the occurrence of overall complications. However, mechanical bowel preparation, antibiotic prophylaxis ≥ 48 h and postoperative nil by mouth showed a significant reduction in major complications. The lowest rate of major complications was found in the group having these three interventions combined (5.9%). Multivariate analyses did not show independent significant results of any of the perioperative care interventions owing to center-specific combinations. At one year follow-up, half of the patients experienced constipation and this was significantly higher among those with preoperative mechanical bowel preparation. Conclusions: Differences in perioperative care interventions do not seem to impact the incidence of overall complications in a large cohort of European rectovestibular fistula-patients. Mechanical bowel preparation, antibiotic prophylaxis ≥ 48 h, and postoperative nil by mouth showed the least major complications. Independency could not be established owing to center-specific combinations of interventions. Type of study: Treatment study. Level of evidence: III</p>},
  author       = {,  and van der Steeg, H. J.J. and van Rooij, I. A.L.M. and Iacobelli, B. D. and Sloots, C. E.J. and Leva, E. and Broens, P. and Fascetti Leon, F. and Makedonsky, I. and Schmiedeke, E. and García Vázquez, A. and Midrio, P. and Lisi, G. and Amerstorfer, E. and Miserez, M. and Fanjul, M. and Ludwiczek, J. and Stenström, P. and Giuliani, S. and van der Steeg, A. F.W. and de Blaauw, I.},
  issn         = {0022-3468},
  keyword      = {Anorectal malformation (ARM),Antibiotic prophylaxis,Complications,Mechanical bowel preparation,Perioperative care,Postoperative feeding regimen},
  language     = {eng},
  month        = {03},
  publisher    = {Elsevier},
  series       = {Journal of Pediatric Surgery},
  title        = {The impact of perioperative care on complications and short term outcome in ARM type rectovestibular fistula : An ARM-Net consortium study},
  url          = {http://dx.doi.org/10.1016/j.jpedsurg.2019.03.008},
  year         = {2019},
}