72322 - Centralization of the surgical care of patients born with anorectal malformations does not reduce short-term complications

Introduction The Swedish National Board of Health and Welfare centralized the surgical care of patients with anorectal malformations from four to two centers in 2018. The aim of this study was to compare short term complications after anorectal reconstruction before and after centralization. Method This was a retrospective review of hospital records, including all children in Sweden who underwent reconstruction of an anorectal malformation 1st of July 2013 to 30th of June 2023, divided into two 5-year periods, before and after centralization. The main outcomes were unplanned readmissions and procedures requiring general anesthesia up to 90 days after the reconstruction, as well as complications classified according to Clavien-Madadi up to 30 days after the procedure. Result Before centralization 173 children underwent anorectal reconstruction compared with 176 children after centralization. Patient groups were comparable with respect to associated malformations and type of anorectal malformation. Eighty (46%) children had a stoma before the anorectal reconstruction prior to centralization and 89 (51%) after (p=0.454). The anorectal reconstruction was performed at median age 61 and 47 days of age, respectively. Unplanned readmissions after anorectal reconstruction were needed in 12 (6%) children before centralization compared with 24 (14%) after (p=0.0520). Unplanned procedures under general anesthesia were required in 21 (12%) children before centralization compared with 24 (14%) after (p=0.294). There were 16 (9%) complications (Clavien-Madadi III-V) within 30 days after anorectal reconstruction before centralization and 12 (7%) after (p=0.856). Discussion Centralization of the surgical care of patients with anorectal malformations in Sweden does not seem to reduce short-term complications.