Abstract
Introduction Children with anorectal malformations (ARMs) benefit from bowel management programs
(BMPs) to manage constipation or fecal incontinence. We aimed to understand the role
of social determinants of health (SDOH) in outcomes following BMPs in this population.
Materials and Methods A single-institution, institutional review board (IRB) approved, retrospective review
was performed in children with ARM who underwent BMP from 2014 to 2021. Clinical,
surgical, and SDOH data were collected. Children were stratified as clean or not clean
per the Rome IV criteria at the completion of BMP. Descriptive statistics were computed.
Categorical variables were analyzed via Fisher's exact tests and continuous variables
with Mood's median tests.
Results In total, 239 patients who underwent BMP were identified; their median age was 6.62
years (interquartile range [IQR]: 4.78–9.83). Of these, 81 (34%) were not clean after
completing BMP. Children with prior history of antegrade enema procedures had a higher
rate of failure. Children who held public insurance, lived within driving distance,
had unmarried parents, lived with extended family, and lacked formal support systems
had a significant association with BMP failure (p < 0.05 for all). Type of ARM, age at repair, type of repair, age at BMP, and type
of BMP regimen were not significantly associated with failure.
Conclusions There is a significant correlation of failure of BMPs with several SDOH elements
in patients with ARM. Attention to SDOH may help identify high-risk patients in whom
additional care may lead improved outcomes following BMP.
Keywords
bowel management - anorectal malformation - social determinants of health - anorectoplasty
- fecal incontinence
