Introduction: Hirschsprung disease (HD) is a congenital disorder of the enteric nervous system, requiring definitive surgical treatment through pull-through procedures. While prematurity generally increases postoperative risk, it remains unclear whether prematurity is associated with worse short-term surgical outcomes in HD patients. This study investigates the association between prematurity and postoperative complications and reoperation rates following pull-through procedures in HD.

Methods: This retrospective cohort study utilized the National Surgical Quality Improvement Program-Pediatric database, identifying HD patients aged 0-18 ys who underwent pull-through surgery from 2016 to 2022. Patients were divided into two groups: preterm (born <37 wk gestation) and full-term (born ≥37 wk gestation). Outcomes of interest included 30-d postoperative complication rates and related reoperations. Univariate and multivariate logistic regression models assessed the association of prematurity with outcomes.

Results: 2603 patients were included, with 296 (11.4%) born preterm. 76.5% were males, and median age at surgery was 4 mos (interquartile range: 0.7-13.6). Overall, the rate of developing any complication was 17.6%. 9.1% of patients had an unplanned reoperation, including 7.4% related to the initial surgery. Premature infants had higher rates of developing any complication (24.3% versus 16.7%; P = 0.001) and related reoperations (10.5% versus 7.0%; P = 0.030) within 30 ds of undergoing pull-through surgery. Multivariate analysis and subsequent subanalysis across age categories confirmed prematurity as an independent predictor of overall complications (adjusted odds ratio: 1.76; 95% confidence interval: 1.23-2.53) and related reoperations (adjusted odds ratio: 2.12; 95% confidence interval: 1.30-3.46) in children less than 1 y of age.

Conclusions: Premature birth is associated with increased complications and related reoperations following pull-through surgery for HD. These findings suggest that prematurity should be considered when managing postoperative care in this population.

Keywords: Congenital aganglionic megacolon; Hirschsprung disease; Prematurity; Pull-through surgery; Surgical outcomes.

Copyright © 2025 Elsevier Inc. All rights reserved.

简介：Hirschsprung病（HD）是一种先天性肠神经系统的疾病，需要通过拉出手术进行确定性的外科治疗。虽然早产通常会增加术后风险，但对于HD患者来说，早产是否与短期手术结果更差有关尚不清楚。本研究探讨了早产与HD患者接受拉出手术后30天内并发症和再手术率之间的关联。

方法：这项回顾性队列研究使用了国家外科质量改进计划-儿科数据库，识别了2016年至2022年间进行过拉出手术的HD患者（年龄为0至18岁）。将患者分为两组：早产儿（妊娠小于37周出生）和足月婴儿（妊娠大于等于37周出生）。研究结果包括术后30天内并发症的发生率以及相关的再手术。通过单变量和多变量逻辑回归模型评估了早产与结果之间的关联。

结果：共纳入2603名患者，其中296名（11.4%）为早产儿。76.5%的患者为男性，手术时中位年龄为4个月（四分位距：0.7-13.6）。总体而言，并发症的发生率为17.6%。9.1%的患者进行了非计划再手术，其中包括7.4%与初次手术相关的再手术。早产儿在术后30天内发生任何并发症的比例较高（24.3％ 对比 16.7％；P = 0.001）以及相关再手术比例也更高（10.5％对比7.0％；P = 0.030）。多变量分析和后续各年龄段的子分析确认了早产是小于一岁儿童整体并发症（校正后的优势比：1.76；95%置信区间：1.23-2.53）以及相关再手术（校正后的优势比：2.12；95%置信区间：1.30-3.46）的独立预测因素。

结论：早产与HD患者接受拉出手术后并发症和相关再手术率增加有关。这些发现表明，应考虑早产作为管理这一人群术后护理时的一个重要因素。

关键词：Hirschsprung病；先天性无神经元巨结肠；早产；拉出手术；外科结果。