Anorectal Malformations at Children's Health: Understanding Our Patient Population, Patterns of Disease, and Surgical Outcomes Over a 10-Year Period
PROBLEM: Children with anorectal malformations require complex procedures and often require long-term bowel management and clinical care for optimal quality of life. The demographics and outcomes of patients with anorectal malformations at Children's Health are unknown. METHODS: The electronic medical record at Children's Health was searched for ICD-9, ICD-10, and CPT(r) codes corresponding to anorectal malformations between 2009 and 2019. Patients who underwent definitive operation prior to Summer 2009 or at another hospital were excluded. Patient demographics, imaging studies, medical history, operative procedures, post-operative complications, and follow-up data were collected and analyzed. IRB approval was attained (STU-2020-0089). RESULTS: 178 patients met inclusion criteria. A definitive anoplasty procedure was performed in 176 patients (55% female), with most (70%) undergoing posterior sagittal anorectoplasty. Patients identified as Hispanic/Latino (n=93, 53%), white (45, 26%), black or African American (22, 12%), and Asian (7, 4%). English (n=122) and Spanish (n=50) were the most common home languages. 144 patients (82%) had a "low" malformation. 117 patients (66%) underwent a staged operation. VACTeRL association was identified in 68 patients (39%). The most common type of malformation was perineal fistula followed by rectovestibular and recto-prostatic urethral fistula in girls and boys, respectively. Out of the 170 patients who underwent a definitive operation and had at least one follow-up visit post-operatively, 18 (11%) had post-operative stricture requiring operative dilation or revision. In our multi-variate regression model, the presence of a cardiac anomaly confers a 4-fold risk of post-operative stricture while each month older at the time of anoplasty reduces the risk by almost 10%. CONCLUSION: We created a data registry for patients with anorectal malformations at Children's Health. The majority of our patients are Hispanic, female, and have an associated anomaly. Anal stricture occurs in about 10% of patients, and children with congenital heart disease may benefit from delay in repair to reduce their increased risk of post-operative stricture. The development of a multidisciplinary program to manage and follow patients long-term is anticipated to improve surgical outcomes and patient retention.
Anal Canal, Anorectal Malformations, Child, Rectovaginal Fistula, Retrospective Studies, Treatment Outcome, Children's Medical Center (Dallas, Tex.), Texas
University of Texas Southwestern Medical Center
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