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Abstract：
Hirschsprung-associated enterocolitis (HAEC) is a serious potential complication after primary pull-through surgery for Hirschsprung\'s disease (HSCR). Administration of anal botulinum toxin (BT) injection may improve obstructive symptoms at the internal anal sphincter, leading to improved fecal passage. The timing of administration and effects on delay or prevention of HAEC are unknown. We hypothesized that BT administration increased the postoperative time to HAEC and aimed to investigate whether anal BT administration after primary pull-through surgery for HSCR is associated with increased time to inpatient HAEC admission development.
We performed a retrospective cohort study examining children with HSCR at US children\'s hospitals from 2008 to 2018 using the Pediatric Health Information System database with an associated primary pull-through operation performed before 60 d of age. The intervention assessed was the administration of BT concerning the timing of primary pull-through, and two groups were identified: PRO (received BT at or after primary pull-through, before HAEC) and NOT (never received BT, or received BT after HAEC). The primary outcome was time from pull-through to the first HAEC admission. The Cox proportional hazards model was developed to examine the BT administration effect on the primary outcome after controlling for patient-level covariates.
We examined a total of 1439 children (67 in the PRO and 1372 in the NOT groups). A total of 308 (21.4%) developed at least one episode of HAEC, including 76 (5.3%) who had two or more episodes. Between 2008 and 2018, the frequency of BT administration has increased from three to 20 hospitals with a frequency of administration between 2.2% and 16.2%. Prophylactic BT (PRO) was not associated with increased time to HAEC event on adjusted analysis.
Among children with HSCR undergoing primary pull-through surgery, prophylactic BT administration did not demonstrate increased time to first HAEC event. A better-powered study with prophylactic BT is required to determine the effect on HAEC occurrence and timing.
Level II (retrospective cohort study).
We performed a retrospective cohort study examining children with HSCR at US children\'s hospitals from 2008 to 2018 using the Pediatric Health Information System database with an associated primary pull-through operation performed before 60 d of age. The intervention assessed was the administration of BT concerning the timing of primary pull-through, and two groups were identified: PRO (received BT at or after primary pull-through, before HAEC) and NOT (never received BT, or received BT after HAEC). The primary outcome was time from pull-through to the first HAEC admission. The Cox proportional hazards model was developed to examine the BT administration effect on the primary outcome after controlling for patient-level covariates.
We examined a total of 1439 children (67 in the PRO and 1372 in the NOT groups). A total of 308 (21.4%) developed at least one episode of HAEC, including 76 (5.3%) who had two or more episodes. Between 2008 and 2018, the frequency of BT administration has increased from three to 20 hospitals with a frequency of administration between 2.2% and 16.2%. Prophylactic BT (PRO) was not associated with increased time to HAEC event on adjusted analysis.
Among children with HSCR undergoing primary pull-through surgery, prophylactic BT administration did not demonstrate increased time to first HAEC event. A better-powered study with prophylactic BT is required to determine the effect on HAEC occurrence and timing.
Level II (retrospective cohort study).
摘要：
先天性巨结肠相关性小肠结肠炎（HAEC）是先天性巨结肠疾病（HSCR）的原发性牵拉手术后的严重潜在并发症。注射肛门肉毒杆菌毒素（BT）可以改善肛门内括约肌的阻塞性症状，导致改善粪便通道。给药时机和对HAEC的延迟或预防的影响尚不清楚。我们假设BT给药增加了HAEC的术后时间，并旨在调查HSCR的初次牵拉手术后肛门BT给药是否与住院HAEC入院时间增加有关。
我们进行了一项回顾性队列研究，从2008年至2018年，在美国儿童医院使用儿科健康信息系统数据库，对患有HSCR的儿童进行了回顾性队列研究，并在60d之前进行了相关的初级牵拉手术。评估的干预措施是关于主要通过时机的BT管理，并确定了两组：PRO（在主要拉拔时或之后接受BT，在HAEC之前)和NOT(从未收到BT，或在HAEC后接受BT)。主要结果是从拉动到第一次HAEC入院的时间。建立了Cox比例风险模型，以检查在控制患者水平的协变量后，BT给药对主要结局的影响。
我们共检查了1439名儿童（PRO组67名，NOT组1372名）。共有308例（21.4％）发生了至少一次HAEC发作，包括76例（5.3％）有两次或更多次发作。在2008年至2018年期间，BT管理的频率从3家增加到20家医院，管理频率在2.2％至16.2％之间。经校正分析，预防性BT（PRO）与HAEC事件发生时间的增加无关。
在接受原发性牵拉手术的HSCR儿童中，预防性BT给药未显示至首次HAEC事件的时间增加.需要更好的预防性BT研究来确定对HAEC发生和时机的影响。
II级（回顾性队列研究）。
我们进行了一项回顾性队列研究，从2008年至2018年，在美国儿童医院使用儿科健康信息系统数据库，对患有HSCR的儿童进行了回顾性队列研究，并在60d之前进行了相关的初级牵拉手术。评估的干预措施是关于主要通过时机的BT管理，并确定了两组：PRO（在主要拉拔时或之后接受BT，在HAEC之前)和NOT(从未收到BT，或在HAEC后接受BT)。主要结果是从拉动到第一次HAEC入院的时间。建立了Cox比例风险模型，以检查在控制患者水平的协变量后，BT给药对主要结局的影响。
我们共检查了1439名儿童（PRO组67名，NOT组1372名）。共有308例（21.4％）发生了至少一次HAEC发作，包括76例（5.3％）有两次或更多次发作。在2008年至2018年期间，BT管理的频率从3家增加到20家医院，管理频率在2.2％至16.2％之间。经校正分析，预防性BT（PRO）与HAEC事件发生时间的增加无关。
在接受原发性牵拉手术的HSCR儿童中，预防性BT给药未显示至首次HAEC事件的时间增加.需要更好的预防性BT研究来确定对HAEC发生和时机的影响。
II级（回顾性队列研究）。
