{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T02:56:31Z","timestamp":1787972191853,"version":"build-2784847793"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,10,5]],"date-time":"2024-10-05T00:00:00Z","timestamp":1728086400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,10,5]],"date-time":"2024-10-05T00:00:00Z","timestamp":1728086400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004047","name":"Karolinska Institute","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004047","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Surg Int"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In Sweden, surgical treatment of Hirschsprung\u2019s disease (HSCR) was centralized from four to two pediatric surgery centers 1st of July 2018. In adults, centralization of surgical care for complex or rare diseases seems to improve quality of care. There is little evidence supporting centralization of pediatric surgical care. The aim of this study was to assess surgical management and postoperative outcome in HSCR patients following centralization of care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study retrospectively analyzed data of patients with HSCR that had undergone pull-through at a pediatric surgery center in Sweden from 1st of July 2013 to 30th of June 2023. Patients managed from 1st of July 2013 to 30th of June 2018 (before centralization) were compared with patients managed from 1st of July 2018 to 30th of June 2023 (after centralization) regarding surgical treatment, unplanned procedures under general anesthesia or readmissions up to 90\u00a0days after pull-through as well as complications classified according to Clavien\u2013Madadi up to 30\u00a0days after pull-through.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In the 5-year period prior to centralization, 114 individuals from 4 treating centers were included and compared to 83 patients from 2 treating centers in the second period. There was no difference regarding age at pull-through or proportion of patients with a stoma prior to pull-through. An increase of laparoscopically assisted endorectal pull-through (8.8% to 39.8%) was observed (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). No significant differences were seen in postoperative hospital stay, unplanned procedures under general anesthesia, or readmissions up to 90 days after pull-through. There was no difference in severe complications (Clavien\u2013Madadi\u2009\u2265\u20093); however, HAEC treated with antibiotics increased following centralization (10.5\u201324.1%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.018).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Centralization of care for HSCR does not seem to delay time to pull-through nor reduce severe complications, unplanned procedures under general anesthesia or readmissions up to 90\u00a0days after pull-through. The increased HAEC rate may be due to increased awareness of mild HAEC.<\/jats:p>\n                    <jats:p>Level of evidence:\u00a0Level III.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00383-024-05842-6","type":"journal-article","created":{"date-parts":[[2024,10,5]],"date-time":"2024-10-05T14:01:54Z","timestamp":1728136914000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["National centralization of Hirschsprung\u2019s disease in Sweden: a comparison of postoperative outcome"],"prefix":"10.1007","volume":"40","author":[{"given":"Linnea","family":"S\u00f6derstr\u00f6m","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Graneli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Rossi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristine","family":"Hagelsteen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Gunnarsdottir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenny","family":"Oddsberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P\u00e4r-Johan","family":"Svensson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena","family":"Borg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matilda","family":"Br\u00e4utigam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabet","family":"Gustafson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"L\u00f6f Granstr\u00f6m","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pernilla","family":"Stenstr\u00f6m","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomas","family":"Wester","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,10,5]]},"reference":[{"issue":"1","key":"5842_CR1","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1038\/s41572-023-00465-y","volume":"9","author":"L Montalva","year":"2023","unstructured":"Montalva L, Cheng LS, Kapur R, Langer JC, Berrebi D, Kyrklund K, Pakarinen M, de Blaauw I, Bonnard A, Gosain A (2023) Hirschsprung disease. Nat Rev Dis Primers 9(1):54. https:\/\/doi.org\/10.1038\/s41572-023-00465-y","journal-title":"Nat Rev Dis Primers"},{"issue":"2","key":"5842_CR2","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1055\/s-0037-1604034","volume":"31","author":"CM Calkins","year":"2018","unstructured":"Calkins CM (2018) Hirschsprung disease beyond Infancy. Clin Colon Rectal Surg 31(2):51\u201360. https:\/\/doi.org\/10.1055\/s-0037-1604034","journal-title":"Clin Colon Rectal Surg"},{"issue":"5","key":"5842_CR3","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1055\/s-0037-1607058","volume":"27","author":"N Durkin","year":"2017","unstructured":"Durkin N, Davenport M (2017) Centralization of pediatric surgical procedures in the United Kingdom. Eur J Pediatr Surg: Off J Austrian Assoc Pediatr Surg 27(5):416\u2013421. https:\/\/doi.org\/10.1055\/s-0037-1607058","journal-title":"Eur J Pediatr Surg: Off J Austrian Assoc Pediatr Surg"},{"issue":"2","key":"5842_CR4","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1016\/j.jpedsurg.2021.10.023","volume":"57","author":"MH Wijnen","year":"2022","unstructured":"Wijnen MH, Hulscher JB (2022) Centralization of pediatric surgical care in the Netherlands: lessons learned. J Pediatr Surg 57(2):178\u2013181. https:\/\/doi.org\/10.1016\/j.jpedsurg.2021.10.023","journal-title":"J Pediatr Surg"},{"issue":"5","key":"5842_CR5","doi-asserted-by":"publisher","first-page":"712","DOI":"10.1097\/SLA.0000000000002965","volume":"268","author":"R Vonlanthen","year":"2018","unstructured":"Vonlanthen R, Lodge P, Barkun JS, Farges O, Rogiers X, Soreide K, Kehlet H, Reynolds JV, K\u00e4ser SA, Naredi P, Borel-Rinkes I, Biondo S, Pinto-Marques H, Gnant M, Nafteux P, Ryska M, Bechstein WO, Martel G, Dimick JB, Krawczyk M, Clavien PA (2018) Toward a consensus on centralization in surgery. Ann Surg 268(5):712\u2013724. https:\/\/doi.org\/10.1097\/SLA.0000000000002965","journal-title":"Ann Surg"},{"issue":"3","key":"5842_CR6","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1055\/s-0041-1723994","volume":"32","author":"O Madadi-Sanjani","year":"2022","unstructured":"Madadi-Sanjani O, Fortmann D, Rolle U, Rodeck B, Sturm E, Pfister ED, Kuebler JF, Baumann U, Schmittenbecher P, Petersen C (2022) Centralization of biliary atresia: has Germany learned its lessons? European J Pediatr Surg\u202f: Off J Austrian Assoc Pediatr Surg 32(3):233\u2013239. https:\/\/doi.org\/10.1055\/s-0041-1723994","journal-title":"European J Pediatr Surg : Off J Austrian Assoc Pediatr Surg"},{"issue":"9418","key":"5842_CR7","doi-asserted-by":"publisher","first-page":"1354","DOI":"10.1016\/S0140-6736(04)16045-5","volume":"363","author":"M Davenport","year":"2004","unstructured":"Davenport M, Ville De, de Goyet J, Stringer MD, Mieli-Vergani G, Kelly DA, McClean P, Spitz L (2004) Seamless management of biliary atresia in England and Wales (1999\u20132002). Lancet (London, England) 363(9418):1354\u20131357. https:\/\/doi.org\/10.1016\/S0140-6736(04)16045-5","journal-title":"Lancet (London, England)"},{"issue":"9","key":"5842_CR8","doi-asserted-by":"publisher","first-page":"1689","DOI":"10.1016\/j.jpedsurg.2011.04.013","volume":"46","author":"M Davenport","year":"2011","unstructured":"Davenport M, Ong E, Sharif K, Alizai N, McClean P, Hadzic N, Kelly DA (2011) Biliary atresia in England and Wales: results of centralization and new benchmark. J Pediatr Surg 46(9):1689\u20131694. https:\/\/doi.org\/10.1016\/j.jpedsurg.2011.04.013","journal-title":"J Pediatr Surg"},{"issue":"2","key":"5842_CR9","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1016\/j.ejso.2022.10.005","volume":"49","author":"AFW van der Steeg","year":"2023","unstructured":"van der Steeg AFW, Jans M, Tytgat G, Fiocco MF, van de Ven C, Terwisscha van Scheltinga CEJ, Pieters R, van Noesel MM, van Dijk AH, Hulsker CCC, Wijnen MHWA (2023) The results of concentration of care: Surgical outcomes of neuroblastoma in the Netherlands. Eur J Surg Oncol: J Euro Soc Surg Oncol Br Assoc Surg Oncol 49(2):505\u2013511. https:\/\/doi.org\/10.1016\/j.ejso.2022.10.005","journal-title":"Eur J Surg Oncol: J Euro Soc Surg Oncol Br Assoc Surg Oncol"},{"issue":"2","key":"5842_CR10","doi-asserted-by":"publisher","first-page":"217","DOI":"10.3390\/children9020217","volume":"9","author":"J Leoni","year":"2022","unstructured":"Leoni J, Rougemont AL, Calinescu AM, Ansari M, Compagnon P, Wilde JCH, Wildhaber BE (2022) Effect of centralization on surgical outcome of children operated for liver tumors in switzerland: a retrospective comparative study. Children (Basel, Switzerland) 9(2):217. https:\/\/doi.org\/10.3390\/children9020217","journal-title":"Children (Basel, Switzerland)"},{"issue":"9","key":"5842_CR11","doi-asserted-by":"publisher","first-page":"1816","DOI":"10.1016\/j.jpedsurg.2024.05.007","volume":"59","author":"L S\u00f6derstr\u00f6m","year":"2024","unstructured":"S\u00f6derstr\u00f6m L, Gunnarsdottir A, Oddsberg J, Svensson PJ, Wester T, Granstr\u00f6m AL (2024) National centralization of Hirschsprung\u2019s disease in Sweden: a comparison of preoperative management and outcomes. J Pediat Surg 59(9):1816\u20131821. https:\/\/doi.org\/10.1016\/j.jpedsurg.2024.05.007","journal-title":"J Pediat Surg"},{"issue":"5","key":"5842_CR12","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1093\/bjs\/znad034","volume":"110","author":"O Madadi-Sanjani","year":"2023","unstructured":"Madadi-Sanjani O, Kuebler JF, Brendel J, Wiesner S, Mutanen A, Eaton S, Domenghino A, Clavien PA, Ure BM (2023) Implementation and validation of a novel instrument for the grading of unexpected events in paediatric surgery: Clavien-Madadi classification. Br J Surg 110(5):576\u2013583. https:\/\/doi.org\/10.1093\/bjs\/znad034","journal-title":"Br J Surg"},{"key":"5842_CR13","unstructured":"Statistics Sweden (SCB) (2024) Antal f\u00f6dda per \u00e5r fr\u00e5n 1900, https:\/\/www.scb.se\/hitta-statistik\/sverige-i-siffror\/manniskorna-i-sverige\/fodda-i-sverige\/ Acessed Aug 2024"},{"issue":"1","key":"5842_CR14","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1186\/s13023-021-01769-6","volume":"16","author":"AL Walter","year":"2021","unstructured":"Walter AL, Baty F, Rassouli F, Bilz S, Brutsche MH (2021) Diagnostic precision and identification of rare diseases is dependent on distance of residence relative to tertiary medical facilities. Orphanet J Rare Dis 16(1):131. https:\/\/doi.org\/10.1186\/s13023-021-01769-6","journal-title":"Orphanet J Rare Dis"},{"issue":"11","key":"5842_CR15","doi-asserted-by":"publisher","first-page":"6456","DOI":"10.3390\/ijerph19116456","volume":"19","author":"J Benito-Lozano","year":"2022","unstructured":"Benito-Lozano J, Arias-Merino G, G\u00f3mez-Mart\u00ednez M, Ancochea-D\u00edaz A, Aparicio-Garc\u00eda A, Posada de la Paz M, Alonso-Ferreira V (2022) Diagnostic process in rare diseases: determinants associated with diagnostic delay. Int J Environ Res Public Health 19(11):6456. https:\/\/doi.org\/10.3390\/ijerph19116456","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"5842_CR16","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1186\/s13023-020-01362-33","volume":"15","author":"K Kyrklund","year":"2020","unstructured":"Kyrklund K, Sloots CEJ, de Blaauw I, Bj\u00f8rnland K, Rolle U, Cavalieri D, Francalanci P, Fusaro F, Lemli A, Schwarzer N, Fascetti-Leon F, Thapar N, Johansen LS, Berrebi D, Hugot JP, Cr\u00e9tolle C, Brooks AS, Hofstra RM, Wester T, Pakarinen MP (2020) ERNICA guidelines for the management of rectosigmoid Hirschsprung\u2019s disease. Orphanet J Rare Dis 15(1):164. https:\/\/doi.org\/10.1186\/s13023-020-01362-33","journal-title":"Orphanet J Rare Dis"},{"issue":"2","key":"5842_CR17","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1002\/bjs.5714","volume":"94","author":"MM Chowdhury","year":"2007","unstructured":"Chowdhury MM, Dagash H, Pierro A (2007) A systematic review of the impact of volume of surgery and specialization on patient outcome. Br J Surg 94(2):145\u2013161. https:\/\/doi.org\/10.1002\/bjs.5714","journal-title":"Br J Surg"},{"issue":"5","key":"5842_CR18","doi-asserted-by":"publisher","first-page":"1015","DOI":"10.1016\/j.jamcollsurg.2012.12.049","volume":"216","author":"D Pieper","year":"2013","unstructured":"Pieper D, Mathes T, Neugebauer E, Eikermann M (2013) State of evidence on the relationship between high-volume hospitals and outcomes in surgery: a systematic review of systematic reviews. J Am Coll Surg 216(5):1015-1025.e18. https:\/\/doi.org\/10.1016\/j.jamcollsurg.2012.12.049","journal-title":"J Am Coll Surg"},{"issue":"1","key":"5842_CR19","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1186\/s13643-016-0376-4","volume":"5","author":"J Morche","year":"2016","unstructured":"Morche J, Mathes T, Pieper D (2016) Relationship between surgeon volume and outcomes: a systematic review of systematic reviews. Syst Rev 5(1):204. https:\/\/doi.org\/10.1186\/s13643-016-0376-4","journal-title":"Syst Rev"},{"issue":"11","key":"5842_CR20","doi-asserted-by":"publisher","first-page":"1177","DOI":"10.1007\/s00383-017-4150-z","volume":"33","author":"A L\u00f6f Granstr\u00f6m","year":"2017","unstructured":"L\u00f6f Granstr\u00f6m A, Wester T (2017) Mortality in Swedish patients with Hirschsprung disease. Pediatr Surg Int 33(11):1177\u20131181. https:\/\/doi.org\/10.1007\/s00383-017-4150-z","journal-title":"Pediatr Surg Int"},{"issue":"9","key":"5842_CR21","doi-asserted-by":"publisher","first-page":"1458","DOI":"10.1016\/j.jpedsurg.2017.01.001","volume":"52","author":"K Bj\u00f8rnland","year":"2017","unstructured":"Bj\u00f8rnland K, Pakarinen MP, Stenstr\u00f8m P, Stensrud KJ, Neuvonen M, Granstr\u00f6m AL, Graneli C, Pripp AH, Arnbj\u00f6rnsson E, Emblem R, Wester T, Rintala RJ, Nordic Pediatric Surgery Study Consortium (2017) A Nordic multicenter survey of long-term bowel function after transanal endorectal pull-through in 200 patients with rectosigmoid Hirschsprung disease. J Pediatr Surg 52(9):1458\u20131464. https:\/\/doi.org\/10.1016\/j.jpedsurg.2017.01.001","journal-title":"J Pediatr Surg"},{"issue":"6","key":"5842_CR22","doi-asserted-by":"publisher","first-page":"977","DOI":"10.1097\/SLA.0b013e3182018542","volume":"252","author":"K Jarvi","year":"2010","unstructured":"Jarvi K, Laitakari EM, Koivusalo A, Rintala RJ, Pakarinen MP (2010) Bowel function and gastrointestinal quality of life among adults operated for Hirschsprung disease during childhood: a population-based study. Ann Surg 252(6):977\u2013981. https:\/\/doi.org\/10.1097\/SLA.0b013e3182018542","journal-title":"Ann Surg"},{"issue":"8","key":"5842_CR23","doi-asserted-by":"publisher","first-page":"1341","DOI":"10.1016\/j.jpedsurg.2014.12.024","volume":"50","author":"KJ Stensrud","year":"2015","unstructured":"Stensrud KJ, Emblem R, Bj\u00f8rnland K (2015) Anal endosonography and bowel function in patients undergoing different types of endorectal pull-through procedures for Hirschsprung disease. J Pediatr Surg 50(8):1341\u20131346. https:\/\/doi.org\/10.1016\/j.jpedsurg.2014.12.024","journal-title":"J Pediatr Surg"}],"container-title":["Pediatric Surgery International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00383-024-05842-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00383-024-05842-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00383-024-05842-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,12]],"date-time":"2024-12-12T12:17:31Z","timestamp":1734005851000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00383-024-05842-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,5]]},"references-count":23,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["5842"],"URL":"https:\/\/doi.org\/10.1007\/s00383-024-05842-6","relation":{},"ISSN":["1437-9813"],"issn-type":[{"value":"1437-9813","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,5]]},"assertion":[{"value":"24 September 2024","order":1,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 October 2024","order":2,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"265"}}