L. C. Pruitt1, D. E. Skarda1, D. C. Barnhart1, E. R. Scaife1, B. T. Bucher1 1University Of Utah,Division Of Pediatric Surgery, Department Of Surgery, School Of Medicine,Salt Lake City, UT, USA
Introduction:
We sought to determine the effect of hospital volume on the outcomes of children treated for esophageal atresia and tracheoesophageal fistula (EA/TEF) at children’s hospitals in the United States.
Methods:
We performed a retrospective cohort study using the PHIS database of children treated at 51 freestanding children’s hospitals from 2007-2017. Children who were admitted under seven days of age with an ICD9/10 for EA/TEF and an ICD9/10 or CPT code for an EA/TEF repair were included. Hospitals were divided into quartiles based on the average annual number of EA/TEF repair operations. Our primary outcome was operation for recurrent TEF within the first year following initial EA/TEF repair. Our secondary outcome was multiple (≥2) esophageal dilations in the first year following surgery. We used generalized linear models to calculate the effect of hospital volume on our primary and secondary outcomes after adjusting for salient patient characteristics.
Results:
There were 1648 patients initially admitted in the first seven days of life who underwent EA/TEF repair in the 10-year period of our study. The mean birth weight was 2528 g with a range of 300g to 6900g. The average annual EA/TEF repair volume by hospital ranged from 0.6-20.1. Redo repair in the first year after EA/TEF repair was rare in the entire cohort (117/1648, 7.1%). 20 patients required a third repair within the first year and three patients required four or more repairs in the first year. The number of dilations per patient ranged from 0-17; 254 (15.4%) patients required two or more dilations in the first year following EA/TEF repair. After adjusting for patient and hospital characteristics, there was no significant association between low- and high-volume hospitals (quartile 1 vs. 4) and need for reoperation in the first year after EA/TEF repair (OR = 1.63, CI = 0.68-4.8, p =0.32), and the occurrence of multiple esophageal dilations (OR= 0.9, CI = 0.6-1.6, p=0.54). There was no significant correlation between the frequency of reoperations and the frequency of recurrent dilations at a given hospital (Figure) (r= 0.20, p = 0.16).
Conclusion:
Our study demonstrated no significant volume-outcome relationship in children treated for EA/TEF at freestanding children’s hospitals, however our primary outcome was rare in our entire cohort.
