title: A comparison of surgical outcomes between in-hours and after-hours tracheoesophageal fistula repairs.
abstract: BACKGROUND
  Emerging 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.
  
  
  METHODS
  With 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.
  
  
  RESULTS
  There 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).
  
  
  CONCLUSIONS
  In 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.
authors.affiliation: Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Anthony
authors.initials: A
authors.lastname: Yeung
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada; Division of Pediatric Surgery, Department of Surgery, British Columbia Children's Hospital, Vancouver, BC, Canada. Electronic address: sbutterworth@cw.bc.ca.
authors.forename: Sonia A
authors.initials: SA
authors.lastname: Butterworth
mesh_terms: D001955:British Columbia / Q000453:epidemiology; D004933:Esophageal Atresia / Q000601:surgery*; D004944:Esophagoplasty / Q000379:methods*; D005260:Female; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014138:Tracheoesophageal Fistula / Q000601:surgery*
keywords: Complications; PICC; Parenteral nutrition; Venous thrombosis