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

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