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The impact of perioperative care on complications and short term outcome in ARM type rectovestibular fistula: An ARM-Net consortium study.

Abstract：

BACKGROUND:The impact of perioperative care interventions on postreconstructive complications and short-term colorectal outcome in patients with anorectal malformation (ARM) type rectovestibular fistula is unknown. METHODS:An ARM-Net consortium multicenter retrospective cohort study was performed including 165 patients with a rectovestibular fistula. Patient characteristics, perioperative care interventions, timing of reconstruction, postreconstructive complications and the colorectal outcome at one year of follow-up were registered. RESULTS:Overall complications were seen in 26.8% of the patients, of which 41% were regarded major. Differences in presence of enterostomy, timing of reconstruction, mechanical bowel preparation, antibiotic prophylaxis and postoperative feeding regimen had no impact on the occurrence of overall complications. However, mechanical bowel preparation, antibiotic prophylaxis ≥48 h and postoperative nil by mouth showed a significant reduction in major complications. The lowest rate of major complications was found in the group having these three interventions combined (5.9%). Multivariate analyses did not show independent significant results of any of the perioperative care interventions owing to center-specific combinations. At one year follow-up, half of the patients experienced constipation and this was significantly higher among those with preoperative mechanical bowel preparation. CONCLUSIONS:Differences in perioperative care interventions do not seem to impact the incidence of overall complications in a large cohort of European rectovestibular fistula-patients. Mechanical bowel preparation, antibiotic prophylaxis ≥48 h, and postoperative nil by mouth showed the least major complications. Independency could not be established owing to center-specific combinations of interventions. TYPE OF STUDY:Treatment study. LEVEL OF EVIDENCE:III.

journal_name

J Pediatr Surg

journal_title

Journal of pediatric surgery

authors

van der Steeg HJJ,van Rooij IALM,Iacobelli BD,Sloots CEJ,Leva E,Broens P,Fascetti Leon F,Makedonsky I,Schmiedeke E,García Vázquez A,Midrio P,Lisi G,Amerstorfer E,Miserez M,Fanjul M,Ludwiczek J,Stenström P,Giuliani S,v

doi

10.1016/j.jpedsurg.2019.03.008

subject

Has Abstract

pub_date

2019-08-01 00:00:00

pages

1595-1600

issue

eissn

0022-3468

issn

1531-5037

pii

S0022-3468(19)30210-6

journal_volume

pub_type

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The impact of perioperative care on complications and short term outcome in ARM type rectovestibular fistula: An ARM-Net consortium study.