Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
J Pediatr Surg. 2021 Jan;56(1):47-54. doi: 10.1016/j.jpedsurg.2020.09.049. Epub 2020 Oct 6.
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).
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.
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).
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 II.
Treatment Study.
背景/目的：本研究评估了在 11 家儿童医院实施 C 型食管闭锁伴远端气管食管瘘（EA/TEF）多机构质量改进管理方案后的依从性。
比较了 2016 年 1 月至 2019 年 1 月期间，在实施 C 型 EA/TEF 修复术围手术期方案包前后，11 家儿童医院的依从性和结果。方案包内容包括在修复过程中消除气管和食管缝线之间的假体材料，修复结束时不留经吻合口的管（无管），术后第 5 天行食管造影，并在术后 24 小时停止预防性抗生素。
共纳入 170 例患者，40%为方案前，60%为方案后。方案实施前，方案依从性从 17.6%增加到 44.1%，增加了 2.5 倍（p<0.001）。在按机构对所有方案组成部分的依从性分层后，43.5%的患者在低依从性中心（<20%）接受治疗，43%在中依从性中心（20-80%），13.5%在高依从性中心（>80%）。方案前和方案后队列的食管漏、吻合口狭窄和全肠喂养时间无差异，但无管依从性与狭窄率呈负相关（ρ=-0.75，p=0.029）。
在研究期间，我们的多机构管理方案的依从性增加了 2.5 倍，而没有影响安全性或喂养时间，并且不支持使用经吻合口管。
二级。
治疗研究。
