Indirect Evidence for the Volume–Outcome Relationship in Corrective Surgery for Hirschsprung Disease: Insights from Adult Colorectal Surgery

Hirschsprung disease (HD) is a rare malformation that requires complex corrective surgery. Low caseload, heterogeneous patient cohorts, and difficulties in linking long-term outcomes to the initial corrective surgery limit the available direct evidence for a volume-outcome relationship. Indirect evidence from adult colorectal cancer (CRC) surgery may be transferable, given the partial similarity of the procedures.Using the Institute for Quality and Efficiency in Health Care (IQWiG) V24-07 rapid report's methodology, this study evaluated the transferability of the volume-outcome relationship from adult CRC surgery to corrective surgery for HD in children. Differences between the two populations were identified and rated for their effect on the transferability of the volume-outcome relationship by an expert panel, following predefined IQWiG V24-07 categories.Consensus was reached for 6 out of 12 criteria. For "disease characteristics," "comorbidities," "intervention," "follow-up," and "concomitant treatments," differences were deemed irrelevant to transferability. For "diagnosis," differences were considered to increase procedural complexity in HD, thereby reinforcing the volume-outcome relationship. Tissue sampling and frozen-section pathology were identified as key challenges. Differences of opinion arose for the remaining criteria, particularly concerning whether the transferability of evidence is limited to rectal resections in adults or includes all colorectal resections. No consensus could be reached on the appropriate caseload threshold for corrective surgery for HD in children.Using the IQWiG V24-07 framework, this study provides strong support for the transferability of the volume-outcome relationship from adult colorectal surgery to corrective surgery for HD. Despite population differences, the underlying mechanisms linking surgical complexity and institutional experience are comparable, reinforcing the relevance of volume-based quality control in pediatric surgery.