# Short-term outcomes of centralization on surgical care for patients with anorectal malformations: retrospective cohort study

## TL;DR

This study examines whether centralizing surgical care for anorectal malformations in Sweden affected short-term patient outcomes.

## Contribution

The study evaluates the impact of centralization on surgical outcomes for anorectal malformations using a national cohort.

## Key findings

- Centralization did not significantly change the rate of unplanned readmissions or surgical procedures.
- Short-term complications remained similar before and after centralization.

## Abstract

The Swedish National Board of Health and Welfare centralized the surgical care of patients with anorectal malformations from four to two centres in 2018. This retrospective review compares short-term complications after anorectal reconstruction before and after centralization.

Hospital records of all infants in Sweden who underwent reconstruction of an anorectal malformation between 1 July 2013 and 30 June 2023 were reviewed and divided in two 5-year periods: before and after centralization. The main outcomes were unplanned readmissions and surgical procedures requiring general anaesthesia up to 90 days after reconstruction, as well as early complications classified according to the Clavien–Madadi system up to 30 days after the procedure.

Before centralization, 173 infants underwent anorectal reconstruction, compared with 176 infants after centralization. Patient groups were comparable with respect to associated malformations and type of anorectal malformation. Before centralization, 80 infants (46.2%) had a colostomy before the anorectal reconstruction, compared with 89 infants (50.6%) after centralization (P = 0.454). Anorectal reconstruction was performed at a median age of 61 and 47 days of age before and after centralization, respectively (P = 0.794). Unplanned readmissions up to 90 days after anorectal reconstruction were needed in 12 infants (6.9%) before centralization, compared with 22 infants (12.5%) after centralization (P = 0.104). Unplanned surgical procedures under general anaesthesia were required in 20 (11.6%) and 22 (12.5%) infants before and after centralization, respectively (P = 0.870). Complications (Clavien–Madadi grade III–V) within 30 days after anorectal reconstruction were seen in 16 (9.2%) and 12 (6.8%) infants before and after centralization, respectively (P = 0.436).

Centralization of the surgical care of patients with anorectal malformations in Sweden did not seem to have an impact on short-term complications.

This retrospective study evaluated the impact of centralizing surgical care for patients with anorectal malformations (ARM) in Sweden. Short-term postoperative outcomes before and after centralization were compared, with a focus on readmissions and unplanned surgical procedures within 90 days, as well as Clavien–Madadi grade III–IV complications within 30 days. The findings suggest that centralization did not significantly affect these short-term outcomes.