Abstract：
BACKGROUND: Surgical treatment of Hirschsprung\'s disease (HSCR) in Sweden was centralized to two tertiary pediatric surgery centers 1st of July 2018. Although complex surgical care in adults seems to benefit from centralization there is little evidence to support centralization of pediatric surgical care. The aim of this study was to assess centralization of HSCR in Sweden, with special consideration to preoperative management and outcomes in this group of patients.
METHODS: This study retrospectively analyzed data of patients with HSCR that had undergone or were planned to undergo pull-through at our center, from 1st of July 2013 to 30th of June 2023. Patients managed from 1st of July 2013 to 30th of June 2018 were compared with patients managed from 1st of July 2018 to 30th of June 2023 regarding diagnostic procedures, preoperative treatment, complications and time to definitive surgery.
RESULTS: Thirty-six patients were managed during the first five-year period compared to 57 during the second period. There was an increased number of patients referred from other Swedish regions to our center following the centralization. Time from diagnosis to pull-through increased from 33 to 55 days after centralization. There were no significant differences in pre-operative management or complications, general or related to stoma.
CONCLUSIONS: Despite increasing patient volumes and longer time from diagnosis to pull through, centralization of care for HSCR does not seem to change the preoperative management and risk of complications. With access to support from the specialist center, transanal irrigations remain a safe mode of at home management until surgery, regardless of distance to index hospital.
METHODS: Level III.
METHODS: This study retrospectively analyzed data of patients with HSCR that had undergone or were planned to undergo pull-through at our center, from 1st of July 2013 to 30th of June 2023. Patients managed from 1st of July 2013 to 30th of June 2018 were compared with patients managed from 1st of July 2018 to 30th of June 2023 regarding diagnostic procedures, preoperative treatment, complications and time to definitive surgery.
RESULTS: Thirty-six patients were managed during the first five-year period compared to 57 during the second period. There was an increased number of patients referred from other Swedish regions to our center following the centralization. Time from diagnosis to pull-through increased from 33 to 55 days after centralization. There were no significant differences in pre-operative management or complications, general or related to stoma.
CONCLUSIONS: Despite increasing patient volumes and longer time from diagnosis to pull through, centralization of care for HSCR does not seem to change the preoperative management and risk of complications. With access to support from the specialist center, transanal irrigations remain a safe mode of at home management until surgery, regardless of distance to index hospital.
METHODS: Level III.
摘要：
背景：2018年7月1日，瑞典Hirschsprung病（HSCR）的手术治疗集中在两个三级儿科手术中心。尽管成年人的复杂外科护理似乎可以从集中化中受益，但几乎没有证据支持儿科外科护理的集中化。这项研究的目的是评估瑞典HSCR的集中化，特别考虑了该组患者的术前管理和结局。
方法：本研究回顾性分析了在我们中心接受或计划接受拉拔的HSCR患者的数据，从2013年7月1日至2023年6月30日。将2013年7月1日至2018年6月30日治疗的患者与2018年7月1日至2023年6月30日治疗的患者进行诊断程序比较。术前治疗,并发症和明确手术的时间。
结果：在第一个五年期间有36名患者得到了治疗，而在第二个期间有57名患者得到了治疗。集中后，从瑞典其他地区转诊到我们中心的患者数量有所增加。集中后，从诊断到拉断的时间从33天增加到55天。术前处理或并发症无显著差异，一般的或与造口有关的。
结论：尽管患者数量增加，从诊断到完成的时间延长，HSCR的集中治疗似乎并未改变术前管理和并发症风险.有了专家中心的支持，在手术之前，经肛门冲洗仍然是家庭管理的安全模式，无论距离索引医院。
方法：三级。
方法：本研究回顾性分析了在我们中心接受或计划接受拉拔的HSCR患者的数据，从2013年7月1日至2023年6月30日。将2013年7月1日至2018年6月30日治疗的患者与2018年7月1日至2023年6月30日治疗的患者进行诊断程序比较。术前治疗,并发症和明确手术的时间。
结果：在第一个五年期间有36名患者得到了治疗，而在第二个期间有57名患者得到了治疗。集中后，从瑞典其他地区转诊到我们中心的患者数量有所增加。集中后，从诊断到拉断的时间从33天增加到55天。术前处理或并发症无显著差异，一般的或与造口有关的。
结论：尽管患者数量增加，从诊断到完成的时间延长，HSCR的集中治疗似乎并未改变术前管理和并发症风险.有了专家中心的支持，在手术之前，经肛门冲洗仍然是家庭管理的安全模式，无论距离索引医院。
方法：三级。
