Attrition rate among patients of Anorectal Malformations on colostomy: A matter of concern

Authors

  • Parveen Kumar Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalaya, New Delhi-110031, India
  • Sauradeep Dey Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalaya, New Delhi-110031, India
  • Ashvin Damdoo Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalaya, New Delhi-110031, India
  • Shishir Kumar Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalaya, New Delhi-110031, India
  • Vivek Manchanda Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalaya, New Delhi-110031, India

DOI:

https://doi.org/10.47338/jns.v13.1306

Keywords:

High ARM, Colostomy, Morbidity, Mortality, Social issues

Abstract

Background: Anorectal malformations (ARM) are correctable congenital malformations with good prognosis. Traditionally it is managed by staged procedure, with diversion colostomy, followed by definitive procedure and stoma reversal in the third stage. It is recommended to complete all stages of repair by 6 months of age for better long-term continence. We had fewer patients coming for definitive surgery and stoma reversal than the patients undergoing colostomy for ARM, so we planned this study to find out the attrition rate among patients undergoing stoma for ARM and explore the reasons for the same.

Methods: An observational study was conducted in the Pediatric Surgery department of Chacha Nehru Bal Chikitsalaya, New Delhi. All the case records of patients with ARM who underwent diversion stoma at our center from January 2018 to December 2019 were retrieved. Further follow-up case records were retrieved with the same Unique Health Identification Number (UHID). When the definitive surgery/ stoma closure was not found in the hospital records till December 2022, the parents were contacted telephonically to find out if the children had undergone definitive surgery at some other center, were awaiting surgery, or had died. The attrition was calculated as the difference between the number of patients for whom a stoma was done and the number of patients who underwent definitive surgery and stoma closure till the data acquisition.

Results: A total of 105 patients were included in the study with male preponderance. Colostomy was done for 73.33% of patients in the neonatal period (77/105). The cloacal malformation was found in 7 (6.67%), rectal atresia in 6 (5.71%), and 9 had congenital pouch colon (8.57%). The age at stoma creation for ARM ranged from 1 day to 9.3 years (mean 0.67 ±1.96 years). Cardiac and renal anomalies were among the major associations. 28 of the neonates (26.67%) had stomal complications. Stomal issues were reported in 32.4%. Mortality was reported in 37 patients (35.24%) including 35 neonates. The attrition rate in our study was found to be 38.24% (26 out of 68). Factors contributing to attrition range from anemia and protracted waiting lists to the anesthesiologist’s pursuit of optimal patient stabilization, alongside familial or personal matters faced by caregivers.

Conclusion: There was a high attrition rate in operated patients of ARM in whom stoma was constructed. The main reasons for the same were anemia and a long surgical waiting list.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

References

Pena A, Levitt M. Anorectal malformations. In: Stringer M, Oldham K, Mouriquand PD, editors. Pediatric Surgery and Urology: Long Term Outcomes. 2nd ed. Cambridge: Cambridge University Press; 2007. p. 401-5.

Shaul DB, Harrison EA. Classification of anorectal malformations-initial approach, diagnostic tests and colostomy. Semin Pediatr Surg. 1997;6:187-95.

Chen CJ. The treatment of imperforate anus: Experience with 108 patients. J Pediatr Surg. 1999;34:1728-32.

Freeman NV, Burge DM, Soar JS, Sedgwick EM. Anal evoked potentials. Eur J Pediatr Surg. 1980;31:22–30.

Albanese CT, Jennings RW, Lopoo JB, Bratton BJ, Harrison MR. One-stage correction of high imperforate anus in the male neonate. J Pediatr Surg. 1999;34:834–6.

Hesse AA, Appeadu-Mensah W. Anorectal Anomalies in Ghana: A Review of 54 Cases: Les anomalies anorectales au Ghana Etude de 54 Cas. Afr J Paediatr Surg. 2006;3(1):4-8.

Chandramouli B, Srinivasan K, Jagdish S, Ananthakrishnan N. Morbidity and mortality of colostomy and its closure in children. J Pediatr Surg. 2004;39(4):596-9.

Sinha SK, Kanojia RP, Wakhlu A, Rawat JD, Kureel SN, Tandon RK. Delayed presentation of anorectal malformations. J Indian Assoc Pediatr Surg. 2008;13(2):64-8.

Kim HL, Gow KW, Penner JG, Blair GK, Murphy JJ, Webber EM. Presentation of low anorectal malformations beyond the neonatal period. Pediatr. 2000;105:E68.

Nour S, Beck J, Stringer MD. Colostomy complications in infants and children. Ann R Coll Surg Engl. 1996;78(6):526-30.

Pena A, Migotto-Krieger M, Levitt MA. Colostomy in anorectal malformations: a procedure with serious but preventable complications. J Pediatr Surg. 2006;41(4):748-56.

Gupta A, Agarwala S, Sreenivas V, Srinivas M, Bhatnagar V. Primary Definitive Procedure versus Conventional Three-staged Procedure for the Management of Low-type Anorectal Malformation in Females: A Randomized Controlled Trial. J Indian Assoc Pediatr Surg. 2017;22(2):87-91.

Menon P, Rao KLN, Sinha AK, Lokesha K, Samujh R, Mahajan JK, et al. Anorectal malformations in males: Pros and cons of neonatal versus staged reconstruction for high and intermediate varieties. J Indian Assoc Pediatr Surg. 2017;22:83-6.

Manjarie AR, Raj S, Babu R. Reasons behind patients defaulting from elective pediatric urology procedures at a tertiary private teaching hospital in South India. J Indian Assoc Pediatr Surg. 2023;28:223-6.

Downloads

Published

2024-05-06

How to Cite

1.
Kumar P, Dey S, Damdoo A, Kumar S, Manchanda V. Attrition rate among patients of Anorectal Malformations on colostomy: A matter of concern. J Neonatal Surg [Internet]. 2024May6 [cited 2024Jun.25];13:20. Available from: https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1306

Issue

Section

Original Article

Most read articles by the same author(s)

1 2 > >>