Social Determinants of Health Are Associated with Failed Bowel Management for Children with Anorectal Malformations

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, IRB-approved, retrospective review was performed in children with ARM who underwent BMP from 2014-2021. Clinical, surgical, and SDOH data were collected. Children were stratified as clean or not clean per 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 There were 239 patients identified who underwent BMP, with median age of 6.62 years [IQR: 4.78 – 9.83]. Of these, 81 (34%) were not clean after completing BMP. Children with prior history of antegrade enema procedures had more 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.