Preoperative underweight is associated with a more complicated perioperative course and impairs recovery in Hirschsprung's disease: The pivotal role of weight-for-age z-score.

BACKGROUND & AIMS: Low weight-for-age z-score (WAZ) is prevalent in children with Hirschsprung's disease (HD), yet its prognostic value for surgical outcomes is unclear. This study evaluated the impact of preoperative WAZ on perioperative course complexity and postoperative recovery in children undergoing pull-through surgery.

METHODS

A retrospective cohort study was conducted on 256 children aged ≤10 years who underwent pull-through. Patients were stratified by preoperative WAZ: underweight (WAZ < -2), at risk of underweight (-2 ≤ WAZ < -1), and well-nourished (WAZ ≥ -1). Demographic, clinical, and perioperative data were analyzed.

RESULTS

Underweight patients showed a higher prevalence of total colonic aganglionosis (26.7%, P = 0.026), longer biopsy-to-treatment intervals (P < 0.001), and higher prior enterostomy rates (P < 0.001). They also had a higher laparotomy rate (36.6%, 11/30). This group experienced the longest postoperative hospital stay (median 13 days, P = 0.033), the highest Hirschsprung-associated enterocolitis (HAEC) readmission rate (46.7%, P = 0.039), and the highest postoperative parenteral nutrition (PN) use (60%). Multivariate analysis identified preoperative nutritional status (WAZ category) as the strongest independent predictor of PN duration. Relative to well-nourished patients, underweight and at-risk children required 10.22-fold (95% CI 4.16-25.13) and 4.34-fold (95% CI 1.70-11.10) longer PN support, respectively (both P < 0.01).

CONCLUSION

Being underweight before pull-through is the strongest independent predictor of prolonged postoperative PN in children with HD. Lower WAZ was associated with more complex surgical pathways, delayed definitive surgery, higher laparotomy rates, longer hospital stays, and increased HAEC readmission risk.