QS306 - Understanding the Long-term Psychosocial and Healthcare Needs of Adults with Congenital Colorectal and Pelvic Malformations

Tuesday, June 4, 2024

8:21 AM – 8:24 AM ET, USA

Location: Room 327

Quick Shot Presenter(s)

ZB

Zeynep Bilgili, MD (she/her/hers)

Postdoctoral Research Fellow
Beth Israel Deaconess Medical Center, Harvard Medical School
Beth Israel Deaconess Medical Center
Boston, MA, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.

Author(s)

SC

Stalin Canizares, n/a

Alumni
Universidad San Francisco de Quito
Boston, Massachusetts, United States

Disclosure information not submitted.
Rodrigo Arean Sanz, MD (he/him/his)

Postdoctoral Research Fellow
Beth Israel Deaconess Medical Center
Boston, MA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Ana Sofia Ore, MD MSc MPH (she/her/hers)

General Surgery Resident
Beth Israel Deaconess Medical Center/ Harvard Medical School
Beth Israel Deaconess Medical Center/Harvard Medical School
Boston, MA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no relevant relationships with ineligible companies.
Evangelos Messaris, MD, Ph.D, MBA

Chief Colon and Rectal Surgery
BIDMC, Harvard Medical School
Boston, Massachusetts, United States

Disclosure information not submitted.
KC

Kristen Crowell, MD

Assistant Professor
Beth Israel Deaconess Medical Center
Boston, Massachusetts, United States

Disclosure information not submitted.
DW

Daniel Wong, MD MHS

Member of the faculty
Beth Israel Deaconess Medical Center; Harvard Medical School
Boston, Massachusetts, United States

Disclosure information not submitted.

Senior Author(s)

TC

Thomas E. Cataldo, MD, FASCRS

Assistant professor of Surgery
Harvard Medical School
Boston, Massachusetts, United States

Disclosure information not submitted.

Purpose/Background: People born with colorectal and pelvic malformations require long-term medical care. While pediatric providers initially manage these conditions, the need for care continues into adulthood for these patients. Even those successfully treated as children will need care in adulthood, emphasizing the need for a well-structured transition in healthcare and research guiding this process. . This study investigated the colorectal surgical outcomes, functional outcomes and psychological impact in patients whohad a prior congenital pelvic abnormality. Given the higher risks associated with chronic medical conditions, we were interested specifically in factors such as co-existing medical conditions, life with a stoma, mental well-being and substance abuse.

Methods/Interventions: With a waiver from our institutional review board, we queried data from the Online Medical Record (OMR) system at our institution. Using ICD-9 and ICD-10 codes, our study identified individuals aged over 18 diagnosed with congenital pelvic and anorectal malformations, which encompassed conditions such as Hirschsprung disease, cloacal deformities, VACTERL syndrome, and others. Distinctively, this study population had their initial surgery and pediatric care elsewhere before seeking adult care at our institution. We obtained data on mental health diagnoses from medical records documented by healthcare professionals, ensuring the study's objectivity.

Results/Outcomes: Including records extending to the inception of our OMR, greater than 30 years, our results identified 35 patients who met the inclusion criteria. This population encompassed various anorectal malformations, with Hirschsprung disease being the most prevalent (60%), followed by cloaca deformities (11.4%), VACTERL syndrome (14.3%), and other unspecified anorectal malformations (14.3%). In our study population, 12 individuals (34.29%) were living with GI stomas. Fifteen patients (42.9%) had diagnosed with psychiatric disorders. The proportion of patients with any psychiatric disorder ranged between 40 and 50% within patients with either Hirschsprung’s disease, cloaca deformities or VACTERL syndrome. Patients with Hirschsprung’s disease had a greater percentage of depression whereas the latter two groups had a bigger proportion of mixed psychiatric disorders. Moreover, eleven patients (31.4%) had a history of drug or alcohol abuse overall. Among those, Hirschsprung disease showed a higher percentage of abuse in comparison to the remaining diseases.

Conclusion/Discussion: This nuanced patient population's characteristics underscore the importance of individualized medical care and support. This study explored the healthcare needs and complexities of patients with pelvic and anorectal malformations. The prevalence of psychiatric disorders and a history of substance abuse in this population highlights the importance of holistic care with different strategies one being including psychosocial providers in multidisciplinary colorectal surgery clinics.