Trisomy 21 Children With Duodenal Atresia or Anorectal Malformation: NSQIP-P Surgical Outcomes Study

Introduction

Patients with Trisomy 21 (T21) have significantly different surgical outcomes when compared to their non-T21 counterparts. Using a national database, we sought to determine if operative complications are increased in T21 patients undergoing duodenal atresia (DA) or anorectal malformation (ARM) surgery, two commonly associated congenital surgical conditions in T21, compared to their non-T21 counterparts.

Materials and methods

We used the deidentified National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database to identify children under 18 with an ICD-9 diagnosis of congenital malformations related to DA or ARM from 2012 to 2020. We stratified patients based on T21 ICD-9 diagnosis. CPT codes were used to identify all surgical procedures related to DA or ARM. Primary outcomes were clinical outcomes (operative time, readmission, reoperation, length of stay [LOS], death) and complications (infectious, cardiac, respiratory, renal, neurological, and hematologic). Unadjusted and adjusted analyses were used for statistical analysis.

Results

Of 2242 patients with DA, 17.5% had T21. The most common procedure overall was enterectomy (38.7%). DA patients with T21 were more likely to be neonates or small children (P = 0.0002), White or Hispanic (P < 0.0001), with cardiac risk factors (P < 0.0001), previous cardiac surgery (P < 0.0001), hematologic disorders (P = 0.0045), underwent elective cases (P < 0.0001), and had higher ASA class (P < 0.0001), compared to non-T21 counterparts. In unadjusted analyses, T21 patients with DA were less likely to have hematologic complications (P < 0.0001). T21 patients with DA were also less likely to have any complications in adjusted analyses (P < 0.0001). Of 2532 patients with ARM, 112 had T21 (4.4%). The most common procedure performed was the perineal/sacroperineal approach repair of a high imperforate anus with a fistula (32.3%). T21 patients with ARM were more likely to be infants (P = 0.0188), older gestational age (P = 0.0008), Hispanic (P < 0.0001), with major or minor cardiac risk factors (P < 0.0001), and higher ASA class (P < 0.0001). In unadjusted analysis, T21 patients with ARM were more likely to have superficial surgical site infections (SSI) (P = 0.0057), organ/space SSI (P = 0.0456), and sepsis (P = 0.0364), compared to their non-T21 counterparts. In adjusted analyses, T21 was not a significant risk factor for any complication (OR 1.79 [0.92, 3.47], P = 0.0866). No differences were found in operative time, unplanned reoperations, readmissions, LOS of more than 30 d, death, or LOS in both DA and ARM patients with and without T21.

Conclusions

This study reveals that T21 patients are less likely to have postoperative complications following DA surgical treatment. However, patients with T21 and ARM have more postoperative complications related to wound healing and infection. Further investigation into these differences may provide insight into how to improve outcomes for T21 patients undergoing other surgical procedures.