A call for personalized transition of care in congenital surgical anomalies: A population-based cohort study on healthcare utilization from birth to adulthood

BACKGROUND: Many children with congenital surgical anomalies (CSA) face complex, lifelong healthcare challenges. We aimed to evaluate long-term healthcare utilization patterns to guide effective transition-of-care strategies. METHODS: Our retrospective population study compared CSA patients (n = 768) to matched controls (n = 7635). Cox and Poisson regression models assessed time-to-event and frequency of ambulatory visits and hospitalizations, adjusting for sex, socioeconomic status (SEFI), family size and rural/urban residency. RESULTS: CSA survivors had earlier (HR = 1.22, 95%CI: 1.12-1.32, p < 0.001) and more frequent ambulatory visits (IRR = 1.62, 95%CI: 1.61-1.64, p < 0.001). CSA cases attended the most annual outpatient visits per child during the first five years post-discharge with esophageal atresia (EA), anorectal malformations (ARM) and Hirschsprung disease having the highest number of contacts. Ambulatory utilization was greater in urban areas and among smaller families, but lower for males. After excluding perinatal hospitalizations, cases were more likely to require hospitalization compared to controls (HR = 3.75, 95%CI: 3.42-4.13, p < 0.001) and were hospitalized more frequently (IRR = 5.63, 95%CI: 5.37-5.89, p < 0.001) at all ages. Lower socioeconomic status, rural setting, female sex and larger households increased the frequency of admission. Cox proportional hazard plots showed that patients with ARM, EA/TEF or Hirschsprung disease required particularly early re-admission after postnatal discharge compared to other CSAs. CONCLUSION: Patients with CSA exhibit persistently high healthcare use, with EA, ARM and Hirschsprung disease requiring particularly intensive follow-up beyond adolescence. Healthcare utilization among CSA patients is influenced by biological sex, family structure and sociodemographic factors. These findings underscore the need for personalized follow-up models beyond childhood.