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Eur J Pediatr Surg
DOI: 10.1055/a-2252-3711
Original Article

Social Determinants of Health Are Associated with Failed Bowel Management for Children with Anorectal Malformations

Shruthi Srinivas 
1   Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, United States
,
Maria E. Knaus
1   Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, United States
,
Drayson Campbell
2   College of Medicine, The Ohio State University, Columbus, Ohio, United States
,
Alberta Negri Jimenez
2   College of Medicine, The Ohio State University, Columbus, Ohio, United States
,
Kristine L. Griffin
3   Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio, United States
,
Gabriella Pendola
2   College of Medicine, The Ohio State University, Columbus, Ohio, United States
,
Alessandra C. Gasior
1   Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, United States
,
Richard J. Wood
3   Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio, United States
,
Ihab Halaweish
1   Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, United States
› Author Affiliations Funding None.
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Abstract

Introduction Children with anorectal malformations (ARMs) benefit from bowel management programs (BMPs) to manage constipation or fecal incontinence. We aimed to understand the role of social determinants of health (SDOH) in outcomes following BMPs in this population.

Materials and Methods A single-institution, institutional review board (IRB) approved, retrospective review was performed in children with ARM who underwent BMP from 2014 to 2021. Clinical, surgical, and SDOH data were collected. Children were stratified as clean or not clean per the Rome IV criteria at the completion of BMP. Descriptive statistics were computed. Categorical variables were analyzed via Fisher's exact tests and continuous variables with Mood's median tests.

Results In total, 239 patients who underwent BMP were identified; their median age was 6.62 years (interquartile range [IQR]: 4.78–9.83). Of these, 81 (34%) were not clean after completing BMP. Children with prior history of antegrade enema procedures had a higher rate of failure. Children who held public insurance, lived within driving distance, had unmarried parents, lived with extended family, and lacked formal support systems had a significant association with BMP failure (p < 0.05 for all). Type of ARM, age at repair, type of repair, age at BMP, and type of BMP regimen were not significantly associated with failure.

Conclusions There is a significant correlation of failure of BMPs with several SDOH elements in patients with ARM. Attention to SDOH may help identify high-risk patients in whom additional care may lead improved outcomes following BMP.

Keywords

bowel management - anorectal malformation - social determinants of health - anorectoplasty - fecal incontinence

Supplementary Material



Publication History

Received: 12 September 2023

Accepted: 19 January 2024

Accepted Manuscript online:
23 January 2024

Article published online:
12 February 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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