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

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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.

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Acknowledgements

The authors would like to thank Janelle Noel-MacDonnell, PHd for her help with the statistical analysis.

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Authors and Affiliations

  1. Department of Surgery, Comprehensive Colorectal Center, Children’s Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA

    Wendy Jo Svetanoff, Charlene Dekonenko, Obiyo Osuchukwu, Tolulope A. Oyetunji, Pablo Aguayo, Jason D. Fraser, David Juang, Charles L. Snyder, Richard Hendrickson, Shawn St. Peter & Rebecca M. Rentea

  2. University of Missouri-Kansas City School of Medicine, Kansas City, USA

    Tolulope A. Oyetunji, Pablo Aguayo, Jason D. Fraser, David Juang, Charles L. Snyder, Richard Hendrickson, Shawn St. Peter & Rebecca M. Rentea

Authors
  1. Wendy Jo Svetanoff
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  2. Charlene Dekonenko
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  3. Obiyo Osuchukwu
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  4. Tolulope A. Oyetunji
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  5. Pablo Aguayo
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  7. David Juang
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  8. Charles L. Snyder
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  9. Richard Hendrickson
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  11. Rebecca M. Rentea
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Contributions

Study conception and design: WJS, RMR. Acquisition of data: WJS, CD, OO, TAO, PA, JDF, DJ, CLS, RH, SSP, RMR. Analysis and interpretation of data: WJS, RMR. Drafting of manuscript: WJS, CD, OO. Critical revision of manuscript: WJS, CD, OO, TAO, PA, JDF, DJ, CLS, RH, SSP, RMR.

Corresponding author

Correspondence to Rebecca M. Rentea.

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Svetanoff, W.J., Dekonenko, C., Osuchukwu, O. et al. Inpatient management of Hirschsprung’s associated enterocolitis treatment: the benefits of standardized care. Pediatr Surg Int 36, 1413–1421 (2020). https://doi.org/10.1007/s00383-020-04747-4

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  • DOI: https://doi.org/10.1007/s00383-020-04747-4

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