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Clinical outcomes following implementation of a management bundle for esophageal atresia with distal tracheoesophageal fistula. J Pediatr Surg 2021 Jan;56(1):47-54

Date

11/03/2020

Pubmed ID

33131776

DOI

10.1016/j.jpedsurg.2020.09.049

Scopus ID

2-s2.0-85094859493 (requires institutional sign-in at Scopus site)   16 Citations

Abstract

BACKGROUND/PURPOSE: This study evaluated compliance with a multi-institutional quality improvement management protocol for Type-C esophageal atresia with distal tracheoesophageal fistula (EA/TEF).

METHODS: Compliance and outcomes before and after implementation of a perioperative protocol bundle for infants undergoing Type-C EA/TEF repair were compared across 11 children's hospitals from 1/2016-1/2019. Bundle components included elimination of prosthetic material between tracheal and esophageal suture lines during repair, not leaving a transanastomotic tube at the conclusion of repair (NO-TUBE), obtaining an esophagram by postoperative-day-5, and discontinuing prophylactic antibiotics 24 h postoperatively.

RESULTS: One-hundred seventy patients were included, 40% pre-protocol and 60% post-protocol. Bundle compliance increased 2.5-fold pre- to post-protocol from 17.6% to 44.1% (p < 0.001). After stratifying by institutional compliance with all bundle components, 43.5% of patients were treated at low-compliance centers (<20%), 43% at medium-compliance centers (20-80%), and 13.5% at high-compliance centers (>80%). Rates of esophageal leak, anastomotic stricture, and time to full feeds did not differ between pre- and post-protocol cohorts, though there was an inverse correlation between NO-TUBE compliance and stricture rate over time (ρ = -0.75, p = 0.029).

CONCLUSIONS: Compliance with our multi-institutional management protocol increased 2.5-fold over the study period without compromising safety or time to feeds and does not support the use of transanastomotic tubes.

LEVEL OF EVIDENCE: Level II.

TYPE OF STUDY: Treatment Study.

Author List

Bence CM, Rymeski B, Gadepalli S, Sato TT, Minneci PC, Downard C, Hirschl RB, Amin RA, Burns RC, Cherney-Stafford L, Courtney CM, Deans KJ, Fallat ME, Fraser JD, Grabowski JE, Helmrath MA, Kabre RD, Kohler JE, Landman MP, Lawrence AE, Leys CM, Mak GZ, Port E, Saito JM, Silverberg J, Slidell MB, St Peter SD, Troutt M, Walker S, Wright T, Lal DR, Midwest Pediatric Surgery Consortium

Authors

Christina Bence MD Assistant Professor in the Surgery department at Medical College of Wisconsin
Dave Lal MD, MPH Chief, Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Child
Esophageal Atresia
Humans
Infant
Postoperative Complications
Retrospective Studies
Tracheoesophageal Fistula
Treatment Outcome