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Repair of congenital esophageal atresia with tracheoesophageal fistula repair in Ontario over the last 20 years: volume and outcomes

Dylkowski D, Dave S, McClure JA, Welk B, Winick-Ng J, Jones S. J Pediatr Surg. 2018; 53(5):925-8. Epub 2018 Feb 8.

Background/Purpose — This study was designed to determine the volume, post-operative surgical outcomes and, if possible, the relationship between outcome and institutional / surgeon volume in neonates undergoing repair of esophageal atresia with tracheoesophageal fistula (EA-TEF) over the last 20 years in Ontario.

Methods — Using administrative databases, a population based cohort study of patients undergoing EA-TEF repair in Ontario between 1993 and 2012 was conducted.

Results — 465 patients with the diagnosis of EA-TEF met inclusion criteria. The mean number of EA-TEF repairs per year per was 5.8. There was a significant difference in hospital annual volume between institutions (range 12.3–3.35: p < 0.05). The average number of cases/surgeon for the last 10 study years ranged between 0.5 and 2 cases/year. Primary outcome revealed that repair of recurrent fistula or intestinal interposition was 5.3%, with no reportable difference between institutions. Secondary outcomes revealed that 45.6% underwent dilatation for esophageal strictures, and 19.8% underwent some type of drainage procedure of the chest. These rates were not significantly different between institutions.

Conclusion — This study provides insight into the outcomes following EA-TEF repair in Ontario and the difficulty in determining surgeon or institution volume outcome relationships, as both primary and secondary outcome event rates are very low.