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

Anorectal Malformations / surgery Antibiotic Prophylaxis Humans Perioperative Care / methods Postoperative Complications / epidemiology Rectal Fistula / surgery Retrospective Studies
Anorectal malformation (ARM) Antibiotic prophylaxis Complications Mechanical bowel preparation Perioperative care Postoperative feeding regimen

Journal

Journal of pediatric surgery
ISSN: 1531-5037
Titre abrégé: J Pediatr Surg
Pays: United States
ID NLM: 0052631

Informations de publication

Date de publication:
Aug 2019
Historique:
received: 05 02 2019
accepted: 04 03 2019
pubmed: 10 4 2019
medline: 27 11 2019
entrez: 10 4 2019
Statut: ppublish

Résumé

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. 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. 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. 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. Treatment study. III.

Sections du résumé

BACKGROUND 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 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 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 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 METHODS
Treatment study.
LEVEL OF EVIDENCE METHODS
III.

Identifiants

DOI: 10.1016/j.jpedsurg.2019.03.008 PMID: 30962020
pubmed: 30962020
pii: S0022-3468(19)30210-6
doi: 10.1016/j.jpedsurg.2019.03.008
pii:
doi:

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

1595-1600

Informations de copyright

Copyright © 2019 Elsevier Inc. All rights reserved.

Auteurs

H J J van der Steeg (HJJ)

Department of Surgery-Pediatric Surgery, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands. Electronic address: herjan.vandersteeg@radboudumc.nl.

I A L M van Rooij (IALM)

Department of Surgery-Pediatric Surgery, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands; Department for Health Evidence, Radboud Institute for Health Sciences, Radboudumc Nijmegen, The Netherlands.

B D Iacobelli (BD)

Department of Medical and Surgical Neonatology, Newborn Surgery Unit, Bambino Gesù Children's Hospital-Research Institute, Rome, Italy.

C E J Sloots (CEJ)

Department of Pediatric Surgery, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands.

E Leva (E)

Department of Pediatric Surgery, Fondazione IRCCS "Ca Granda"-Ospedale Maggiore Policlinico, Milan, Italy.

P Broens (P)

Department of Surgery, Division of Pediatric Surgery, University Medical Centre Groningen, Groningen, The Netherlands.

F Fascetti Leon (F)

Department of Pediatric Surgery, University of Padua, Padua, Italy.

I Makedonsky (I)

Department of Pediatric Surgery, Children's Hospital Dnepropetrovsk, Dnepropetrovsk, Ukraine.

E Schmiedeke (E)

Department of Pediatric Surgery and Urology, Centre for Child and Youth Health, Klinikum Bremen-Mitte, Bremen, Germany.

A García Vázquez (A)

Department of Pediatric Surgery, University Hospital 12 de Octubre, Madrid, Spain.

P Midrio (P)

Department of Pediatric Surgery, Ca' Foncello Hospital, Treviso, Italy.

G Lisi (G)

Department of Pediatric Surgery, University "Gabriele d'Annunzio " of Chieti-Pescara - "Santo Spirito" Hospital, Pescara, Italy.

E Amerstorfer (E)

Department of Pediatric and Adolescent Surgery, Medical University of Graz, Austria.

M Miserez (M)

Department of Abdominal Surgery, UZ Leuven, Leuven, Belgium.

M Fanjul (M)

Department of Pediatric Surgery, Hospital Gregorio Maranon, Madrid, Spain.

J Ludwiczek (J)

Department of Pediatric Surgery, Kepler Universitätsklinikum GmbH, Linz, Austria.

P Stenström (P)

Department of Pediatric Surgery, Lund University, Skane University Hospital, Lund, Sweden.

S Giuliani (S)

Department of Pediatric Surgery, St George's Hospital and University, London, United Kingdom.

A F W van der Steeg (AFW)

Department of Pediatric Surgery, Emma Children's Hospital, AMC and VU University Medical Center, Amsterdam, The Netherlands.

I de Blaauw (I)

Department of Surgery-Pediatric Surgery, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands.

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Classifications MeSH

questionsmedicales.fr › Malformations et maladies congénitales, héréditaires et néonatales › Malformations › Malformations de l'appareil digestif › Malformations anorectales › The impact of perioperative care on...
questionsmedicales.fr › Thérapeutique › Traitement médicamenteux › Prémédication › Antibioprophylaxie › The impact of perioperative care on...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › The impact of perioperative care on...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Soins périopératoires › The impact of perioperative care on...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Complications postopératoires › The impact of perioperative care on...
questionsmedicales.fr › États, signes et symptômes pathologiques › États anatomopathologiques › Fistule › Fistule digestive › Fistule intestinale › Fistule rectale › The impact of perioperative care on...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › The impact of perioperative care on...