A comparison of surgical outcomes between in-hours and after-hours tracheoesophageal fistula repairs

Abstract

BackgroundEmerging literature has found increased complications for some patients undergoing nonemergent surgeries performed after-hours. For infants born with esophageal atresia and tracheoesophageal fistula (EA/TEF), no literature exists addressing the impact of the timing of surgery on outcomes. MethodsWith IRB approval, EA/TEF repairs (2005–2010) performed at a tertiary children's hospital were reviewed retrospectively. All patients had an esophageal anastomosis. After-hours surgeries were defined as 1530–0800 Monday to Friday, weekends/holidays. Demographics, EA/TEF type, operative details, anastomotic tension, and complications were compared. Outcomes measured included intraoperative desaturations, esophageal complications (leak, stricture, recurrence), pneumothorax, and mortality. ResultsThere were 28 patients, of which 21 underwent the procedure in-hours and 7 after-hours. Patient age, gestational age, weight, EA/TEF type, cardiac anomalies, and preoperative, intraoperative, and postoperative variables were not different between the groups. Operative time, intraoperative desaturations, anastomotic tension, blood loss, total ventilation days, or length of hospitalization were not significantly different. There was a significant increase in esophageal leaks in the after-hours group (n=3) vs. the in-hours (n=0) group (p=0.014). ConclusionsIn this study, infants with an EA/TEF repaired after-hours had a significant increase in anastomotic leaks. The observed increase in leaks requires further evaluation to ensure more optimal outcomes for this fragile group of patients.