Perioperative outcomes of neonatal versus delayed surgery for Hirschsprung disease: a nationwide retrospective cohort study in Japan

Abstract

Purpose: To assess the safety and short-term outcomes of neonatal surgery for Hirschsprung disease. Methods: This retrospective cohort study extracted data from a nationwide Japanese inpatient database from July 2010 to March 2021. Patients diagnosed with Hirschsprung disease within 30 days of life who underwent definitive surgery within 120 days of life were identified. Patients who underwent enterostomy before definitive surgery and those who were diagnosed with the extended type of Hirschsprung disease were excluded. We stratified patients who underwent definitive surgery within 30 days of life into the neonatal group (n = 65), and the others into the non-neonatal group (n = 300). Propensity-score overlap weighting analyses were employed to compare the outcomes between the two groups. Results: Overlap weighting analysis revealed no significant difference in in-hospital morbidity (risk difference [95% confidence interval], −4.6 [−16.8–7.5]). Although the post-operative length of stay was longer (difference, 6.5 [−0.1 to −13.0] days), the total length of stay during infancy (difference, 14.6 [6.3 to 22.8] days) was shorter in the neonatal group than in the non-neonatal group. Conclusions: This nationwide cohort study found that although in-hospital morbidity was similar between definitive surgery for Hirschsprung disease performed in the neonatal and non-neonatal periods, neonatal surgery was associated with a shorter total length of hospitalization during infancy compared with delayed surgery. In terms of the short-term outcomes, neonatal surgery for Hirschsprung disease is safe, and delayed surgery may not be beneficial.