Perioperative outcomes of neonatal versus delayed surgery for Hirschsprung disease: A nationwide retrospective cohort study in Japan

Purpose : To evaluate the safety and advantages of neonatal surgery for Hirschsprung disease. Methods: This retrospective cohort study extracted data from a nationwide Japanese inpatient database from July 2010 to March 2021. Patients who were diagnosed with Hirschsprung disease within 30 days of life and underwent primary definitive surgery within 120 days of life were identified. We stratified patients who underwent definitive surgery within 30 days of life into the neonatal group (n=65), and the others into the non-neonatal group (n=300). Propensity-score overlap weighting analyses were employed to compare the outcomes between the two groups. Results: Overlap weighting analysis revealed no significant difference in in-hospital morbidity (risk difference [95% confidence interval], -4.6 [-16.8–7.5]). However, the total length of stay during infancy(difference, 14.6 [6.3–22.8] days) was shorter in the neonatal group than in the non-neonatal group. Conclusions: This nationwide cohort study found that although in-hospital morbidity was similar between definitive surgery for Hirschsprung disease performed in the neonatal and non-neonatal periods, neonatal surgery was associated with a shorter total length of hospital stay during infancy compared with delayed surgery. While neonatal surgery for Hirschsprung disease is safe, delayed surgery may not be beneficial.