Minimizing variance in pediatric patients after repair of anorectal malformations.

Purpose: A standardized anorectal malformation (ARM) perioperative protocol was implemented across two pediatric tertiary hospitals. The protocol addressed antibiotic duration, feeding advancement, VACTERL workup, and wound management. We aim to evaluate complications, length of stay (LOS), and protocol compliance.

Methods: Introduced in June 2020, data from a 24-month protocol cohort (after a 6-month transition) were compared to a 24-month control cohort. Outcomes included demographics, compliance, complications and LOS.

Results: Forty-five patients were included (control: 26, protocol: 19). Most were diagnosed with rectoperineal fistula (53%), 42% had significant cardiac disease, and 44% underwent prior colostomy. VACTERL workup was completed in 89%. Thirty-five patients underwent posterior sagittal anorectoplasty, and 10 cutback anoplasty. Median postoperative LOS was unchanged (control: 2 days; protocol: 2 days, p=0.80). Total LOS showed no difference (control: 3 days, protocol: 2 days, p = 0.51). No wound infections occurred. Wound dehiscence occurred in 1 control and 2 protocol patients (p=0.57). Compliance was 53% with deviations attributed to early diet initiation (n=4), incomplete VACTERL workup (n=2), and wound care (n=2).

Conclusion: A standardized ARM perioperative protocol is feasible across institutions. It maintained excellent outcomes, including short LOS and few complications, though the small sample limited statistical power.