Lower Childhood Opportunity Index is Associated with Delayed Diagnosis of Anorectal Malformations.

Purpose: Delay in diagnosis of anorectal malformations (ARM) can potentially lead to adverse events. Perineal and rectovestibular fistulas are more likely to be missed on exam compared to other ARM subtypes. We aimed to identify which clinical factors and social determinants of health (SDOH) elements may be associated with missed diagnosis of these ARMs.

Methods: A retrospective review was performed of all infants with perineal or rectovestibular fistulas seen at a single center from 2014 to 2023. Delayed diagnosis was defined as those made beyond the second day of life. Data were collected regarding birth hospital NICU acuity, location of diagnosis, clinical factors, adverse sequelae, and SDOH, including Child Opportunity Index (COI). Categorical variables were analyzed via Fisher's Exact Test. Ordinal variables were analyzed using Cochran-Armitage Test for Trend.

Results: A total of 172 patients were diagnosed with perineal or rectovestibular fistula during the time period, of which 31.9% had delay in diagnosis (Table 1). There was no significant difference in acuity level of the birth hospital, race, ethnicity, insurance type, non-English language preference (NELP), or rural vs. urban setting between delayed and timely diagnosis. As COI increased in the cohort, there was a significant trend toward lower association with delayed diagnosis (Table 1). Those with delayed diagnosis were more likely to present with fecal impaction or have an unplanned pre-operative admission (p<0.001).

Conclusion: In this study, patients with lower COI experienced higher likelihood of delayed diagnosis of ARM. Efforts should be made to improve prompt diagnosis in this at-risk population.

Level of evidence: III.