Surgeon-Level Variation in Outcome following Esophageal Atresia Repair Is Not Explained by Volume.

Area of Science:

• Pediatric Surgery
• Surgical Outcomes Research
• Congenital Anomalies

Background:

• Esophageal atresia (EA) repair outcomes are crucial for pediatric surgical care.
• Assessing the impact of surgeon seniority on EA repair is essential for quality improvement.
• The Clavien-Dindo classification system provides a standardized method for grading surgical complications.

Purpose of the Study:

• To determine if surgeon seniority (years in practice or case volume) affects operative outcomes in esophageal atresia (EA) repair.
• To analyze surgeon-specific outcomes using the Clavien-Dindo score for EA procedures.
• To identify factors influencing EA repair success.

Main Methods:

• Retrospective analysis of 190 EA repairs over 22 years in a regional center.
• Outcomes assessed included mortality, anastomotic leak, need for dilatation, and Clavien-Dindo grade ≥3b.
• Exploratory variables included surgeon experience, prior repairs, and infant-specific factors.

Main Results:

• No significant association found between consultant experience and objective outcomes.
• Sequential analysis revealed significant variation in Clavien-Dindo events (≥3b) among surgeons.
• Surgeon performance deterioration was observed in one instance; mortality linked to comorbidities.

Conclusions:

• Surgeon-level variations in EA repair outcomes exist but are not explained by case volume or experience.
• Individual surgeon performance in EA repair can deteriorate over time.
• Centralizing EA surgery to fewer centers or surgeons is not supported by this data to improve patient outcomes.