Social Determinants of Health Are Associated with Failed Bowel Management for Children with Anorectal Malformations.

IF 1.5 3区医学 Q2 PEDIATRICS

European Journal of Pediatric Surgery Pub Date : 2024-02-12 DOI:10.1055/a-2252-3711

Shruthi Srinivas, Maria E Knaus, Drayson Campbell, Alberta Negri Jimenez, Kristine L Griffin, Gabriella Pendola, Alessandra C Gasior, Richard J Wood, Ihab Halaweish

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引用次数: 0

Abstract

Introduction: Children with anorectal malformations (ARMs) benefit from bowel management programs (BMPs) to manage constipation or fecal incontinence. We aimed to understand the role of social determinants of health (SDOH) in outcomes following BMPs in this population.

Materials and methods: A single-institution, institutional review board (IRB) approved, retrospective review was performed in children with ARM who underwent BMP from 2014 to 2021. Clinical, surgical, and SDOH data were collected. Children were stratified as clean or not clean per the Rome IV criteria at the completion of BMP. Descriptive statistics were computed. Categorical variables were analyzed via Fisher's exact tests and continuous variables with Mood's median tests.

Results: In total, 239 patients who underwent BMP were identified; their median age was 6.62 years (interquartile range [IQR]: 4.78-9.83). Of these, 81 (34%) were not clean after completing BMP. Children with prior history of antegrade enema procedures had a higher rate of failure. Children who held public insurance, lived within driving distance, had unmarried parents, lived with extended family, and lacked formal support systems had a significant association with BMP failure (p < 0.05 for all). Type of ARM, age at repair, type of repair, age at BMP, and type of BMP regimen were not significantly associated with failure.

Conclusions: There is a significant correlation of failure of BMPs with several SDOH elements in patients with ARM. Attention to SDOH may help identify high-risk patients in whom additional care may lead improved outcomes following BMP.

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健康的社会决定因素与肛门直肠畸形儿童肠道管理失败有关。

引言患有肛门直肠畸形（ARM）的儿童可以通过肠道管理计划（BMP）来控制便秘或大便失禁。我们的目的是了解健康的社会决定因素（SDOH）在该人群实施 BMP 后的结果中的作用。材料与方法我们对 2014-2021 年期间接受 BMP 的 ARM 患儿进行了一次单一机构、经 IRB 批准的回顾性审查。收集了临床、手术和 SDOH 数据。在 BMP 完成时，根据罗马 IV 标准将患儿分为清洁和非清洁两类。计算描述性统计。分类变量通过费雪精确检验进行分析，连续变量通过穆德中位数检验进行分析。结果 239 名患者接受了 BMP 治疗，中位年龄为 6.62 岁[IQR：4.78 - 9.83]。其中 81 人（34%）在完成 BMP 后未进行清洁。曾接受过逆行灌肠手术的儿童失败率更高。持有公共保险、居住在车程范围内、父母未婚、与大家庭生活在一起以及缺乏正规支持系统的儿童与 BMP 失败有显著关系（P＜0.05）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Pediatric Surgery 医学-外科

CiteScore

3.90

自引率

5.60%

发文量

审稿时长

6-12 weeks

期刊介绍： This broad-based international journal updates you on vital developments in pediatric surgery through original articles, abstracts of the literature, and meeting announcements. You will find state-of-the-art information on: abdominal and thoracic surgery neurosurgery urology gynecology oncology orthopaedics traumatology anesthesiology child pathology embryology morphology Written by surgeons, physicians, anesthesiologists, radiologists, and others involved in the surgical care of neonates, infants, and children, the EJPS is an indispensable resource for all specialists.