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


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.



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.

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