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Educational and mental health outcomes in school-aged children with anorectal malformations: A case-control cohort study

  • Author Footnotes
    1 Address: 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan.
    Yuichiro Miyake
    Footnotes
    1 Address: 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan.
    Affiliations
    University of Manitoba, Department of Surgery, Division of Pediatric Surgery and Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada

    Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
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  • Author Footnotes
    1 Address: 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan.
    Suyin A. Lum Min
    Footnotes
    1 Address: 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan.
    Affiliations
    University of Manitoba, Department of Surgery, Division of Pediatric Surgery and Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
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  • Author Footnotes
    1 Address: 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan.
    Atsuyuki Yamataka
    Footnotes
    1 Address: 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan.
    Affiliations
    Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
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  • Author Footnotes
    1 Address: 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan.
    Richard Keijzer
    Correspondence
    Corresponding author. Address: AE402-820 Sherbrook Street, Winnipeg, Manitoba, Canada, R3A 1S1. Tel.: +2047871246.
    Footnotes
    1 Address: 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan.
    Affiliations
    University of Manitoba, Department of Surgery, Division of Pediatric Surgery and Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
    Search for articles by this author
  • Author Footnotes
    1 Address: 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan.

      Highlights

      • What is currently known about this topic?
      Advances in surgical treatment have improved anorectal malformation patients’ quality of life (QOL).
      • What new information is contained in this article?
      Patients with a history of anorectal malformation are more likely to perform poorly in junior high school, but in high school they achieve the same academic standards as their peers.
      Anorectal malformation patients are at greater risk of neurodevelopmental and mental health disorders than controls.

      Summary

      Purpose

      Outcome studies for patients with anorectal malformation (ARM) have focused on fecal incontinence and quality of life, but a comparison of educational outcomes between ARM cases and controls has not been reported. The purpose of this study was to assess real-world educational outcomes, neurodevelopmental disorders and mental health disorders in ARM patients and compare to an age-matched control group.

      Methods

      We performed a retrospective case-control study of children diagnosed with ARM from 1991 to 2017. We evaluated educational outcomes using an Early Developmental Instrument, Grades 3, 7, and 8 assessments, Grade 9 completion and performance, high school graduation. Neurodevelopmental and mental health disorders were compared using International Classification of Diseases codes available from a population-based dataset.

      Results

      A total of 96 ARM cases and 960 controls were identified. Cases were at greater risk of failing to meet expectations on Grades 7 and 8 assessments. After entering high school, ARM patients were at no greater risk than their peers of failing to meet expectations. Cases were more likely to have a developmental or intellectual disability (OR 3.59, p<0.001), anxiety (OR 1.86, p=0.023), depression (OR 2.35, p=0.022) or hyperactivity disorder (OR 2.01, p=0.036).

      Conclusions

      Our study demonstrated that ARM patients may be more likely to perform poorly in junior high school than controls and may be at greater risk of neurodevelopmental and mental health disorders. It is important for pediatric surgeons to anticipate these challenges and endorse psychosocial supports to optimize educational and mental health outcomes.

      Keywords

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