Child Opportunity Index is Not Associated With Cleanliness in Patients With Anorectal Malformations Treated at Pediatric Colorectal Centers: A Multi-Institutional Study

Shruthi Srinivas, Department of Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
Caitlin A. Smith, Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.
Kelly Austin, Department of Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
Jeffrey R. Avansino, Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.
Andrea Badillo, Department of Surgery, Children's National Hospital, George Washington University, Washington, DC, USA.
Casey M. Calkins, Department of Surgery, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA.
Rachel C. Crady, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
Belinda H. Dickie, Department of Surgery, Boston Children's Hospital, Harvard University, Boston, MA, USA.
Megan M. Durham, Department of Surgery, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA.
Jason S. Frischer, Department of Surgery, Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, OH, USA.
Julia E. Grabowski, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, USA.
Jamie Harris, Department of Surgery, Phoenix Children's Hospital, University of Arizona, Phoenix, AZ, USA.
Ankur Rana, Department of Surgery and Perioperative Care, Dell Children's Medical Center, University of Texas Austin, Austin, TX, USA.
Ron W. Reeder, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
Rebecca M. Rentea, Department of Surgery, Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, MO, USA.
Michael D. Rollins, Department of Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA.
Payam Saadai, Department of Surgery, UC Davis Children's Hospital, University of California Davis, Davis, CA, USA.
K Elizabeth Speck, Division of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA.
Richard J. Wood, Department of Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
Ihab Halaweish, Department of Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA. Electronic address: Ihab.Halaweish@NationwideChildrens.org.

Document Type

Journal Article

Publication Date

4-1-2025

Journal

Journal of pediatric surgery

Volume

60

Issue

4

DOI

10.1016/j.jpedsurg.2024.162149

Keywords

Antegrade continence enemas; Bowel management programs; Cloaca; Social determinants of health

Abstract

BACKGROUND: Individually collected social determinants of health (SDOH) have been associated with negative outcomes in children with anorectal malformations (ARMs). Our aim was to assess whether the Child Opportunity Index (COI) is associated with bowel management strategy and fecal cleanliness in patients with ARM managed at specialized pediatric colorectal centers. We hypothesized that children from low COI would have lower rates of cleanliness. METHODS: A multi-institutional retrospective review evaluated children ≥4 years old with ARM treated at centers participating in the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC), excluding patients with ostomies. The primary exposure was COI, obtained by ZIP code. The primary outcome was fecal cleanliness, defined as ≤1 weekly stool accident. Additional variables evaluated included demographics, ARM severity, bowel management type, medical comorbidities, and complications in those undergoing antegrade continence enema procedures. COI groups were compared for trend (p-value ≤0.05 as significant). RESULTS: The cohort included 550 patients, most (75.1%) residing in moderate, high, or very high opportunity areas. There were no differences in ARM severity between COI groups. Stratified by age, there were no differences in fecal cleanliness (p = 0.788) or bowel management strategy (p = 0.224) by COI. There were few overall complications from ACE placement (12.3%), but ACE complications were more common in children from low-opportunity areas (22.2% vs 2.9%; p = 0.01). CONCLUSION: Contrary to hypothesized, children with anorectal malformations managed at tertiary institutions within PCPLC do not differ by COI in bowel management strategy or fecal cleanliness outcome. Further investigation into individual disparities may be more important in these patients. LEVEL OF EVIDENCE: III = retrospective comparative study.

Department

Surgery

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