#25 The surgical management of congenital anomalies: A long-term follow-up study
Hailey V Hildebrand, The University of Winnipeg; Matthew Levesque, The University of Manitoba; Suyin A Lum Min, The University of Manitoba; Richard Keijzer, The University of Manitoba; Melanie I Morris, The University of Manitoba; B.J Hancock, The University of Manitoba; Nathan Wiseman, The Univeristy of Manitoba; Anna Shawyer, The Univerisity of Manitoba
The management of babies born with congenital surgical anomalies (CSA) has evolved over the last several decades. And, as management strategies evolved short-term outcomes improved. However, long-term outcomes have been poorly reported. The objective of this project was to establish a comprehensive database of children with CSA managed in Winnipeg over the last 25 years.
A retrospective chart review was performed of all patients with a CSA managed at HSC or St. Boniface between 1991 and 2016. The CSA included intestinal atresia, imperforate anus, congenital diaphragmatic hernia, gastroschisis, omphalocele, Hirschsprung’s disease, and congenital lung lesions. The data extracted included demographics, family history, prenatal diagnostics, details of surgical management, and anomaly specific information. This information was entered into a REDCap database.
585 patients with 602 anomalies have been entered into the database (Table 1). The most common anomaly was gastroschisis (27%); congenital lung lesions were the least common (6.7%). Maternal risk factors which include, smoking, narcotics, alcohol or marijuana, were common for all anomalies (25-58%). However, gastroschisis patients were more likely to have a mother with risk factors than the average CSA patient. Males were more common in all anomalies except lung lesions. Mortality varied significantly between anomalies; approximately 25% of congenital diaphragmatic hernia and omphalocele patients died versus 1% of Hirschsprung’s patients. Omphalocele patients were found to have mothers that were 2.5 years older than average (29 years) while children with gastroschisis had mothers that were 5.3 years younger than average (21 years).
By reviewing our experience of CSA, we have identified several significant trends. We will continue to analyze the retrospective data, start to prospectively populate the database, and eventually establish a standardized long-term follow-up clinic to determine long-term outcomes.