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Repair of Oseophageal atrisia by consultants and supervised trainees results in similar outcomes

Repair of Oseophageal atrisia by consultants and supervised trainees results in similar outcomes
Repair of Oseophageal atrisia by consultants and supervised trainees results in similar outcomes
Aims: consultants and trainees require exposure to complex cases for maintainingand gaining operative experience. Oesophageal atresia (OA) repair is a neonatalsurgical case with indicative numbers for completion of training. A conflict of interestmay exist between adequate training, maintaining consultant experience andachieving good outcomes. We aimed to review outcomes of cases performedprimarily by trainees compared to those by a consultant.

Methods: retrospective casenote review of all consecutive infants who underwentsurgical repair of OA with distal Tracheo-Oesophageal Fistula (TOF) between Jan1994 and Dec 2014. Only cases that underwent primary oesophageal anastomosiswere included. Surgical Outcomes were compared between cases that had trainee orconsultant listed as primary operator.

Results:one hundred and twenty-two cases were included. Fifty-two cases were operated by a trainee, 68 by a consultant (2 cases undeterminable and excluded). Infant demographics, clinical characteristics and duration of f ollow-up were similarbetween groups. All infants survived to discharge. C ases operated by a trainee andconsultant as primary operator had a similar incidence of postoperative pneumothorax (trainee 4 vs consultant 3; p=0.46), anastomotic leak (5vs 3; p=0.29) and recurrentTOF (0vs 2; p=0.5). Overall 52% of cases had an anastomotic dilatation during follow-up with no difference between trainee and consultant groups (50%vs 53%;p=0.85).

Conclusion: surgical outcomes for repair of OA/TOF are not adversely affected by trainee operating. Trainees with a ppropriate skills should perform supervised OA/TOF repair. These data are important for understanding the inter-relationship between provision of training and surgical outcomes
0035-8843
510-513
Hall, Nigel
6919e8af-3890-42c1-98a7-c110791957cf
Jones, Ceri E.
1c29d621-82b7-4d1d-ab28-03da0cb7fb4d
Smyth, R
31626d86-50d4-40f3-a928-7f1895c8bf95
Keys, S
34655f67-5e19-4f62-a982-0439ceada6ca
Stanton, M
5a5e0bee-b8e4-4452-9204-ca57f8edb7c4
Kitteringham, L.
76323b89-f42d-4044-84b7-5eaacb81a1d5
Wheeler, R.A.
5ffea06b-c518-4038-b6b7-fd03eb18777c
Hall, Nigel
6919e8af-3890-42c1-98a7-c110791957cf
Jones, Ceri E.
1c29d621-82b7-4d1d-ab28-03da0cb7fb4d
Smyth, R
31626d86-50d4-40f3-a928-7f1895c8bf95
Keys, S
34655f67-5e19-4f62-a982-0439ceada6ca
Stanton, M
5a5e0bee-b8e4-4452-9204-ca57f8edb7c4
Kitteringham, L.
76323b89-f42d-4044-84b7-5eaacb81a1d5
Wheeler, R.A.
5ffea06b-c518-4038-b6b7-fd03eb18777c

Hall, Nigel, Jones, Ceri E., Smyth, R, Keys, S, Stanton, M, Kitteringham, L. and Wheeler, R.A. (2020) Repair of Oseophageal atrisia by consultants and supervised trainees results in similar outcomes. Annals of The Royal College of Surgeons of England, 102 (7), 510-513. (doi:10.1308/rcsann.2020.0087).

Record type: Article

Abstract

Aims: consultants and trainees require exposure to complex cases for maintainingand gaining operative experience. Oesophageal atresia (OA) repair is a neonatalsurgical case with indicative numbers for completion of training. A conflict of interestmay exist between adequate training, maintaining consultant experience andachieving good outcomes. We aimed to review outcomes of cases performedprimarily by trainees compared to those by a consultant.

Methods: retrospective casenote review of all consecutive infants who underwentsurgical repair of OA with distal Tracheo-Oesophageal Fistula (TOF) between Jan1994 and Dec 2014. Only cases that underwent primary oesophageal anastomosiswere included. Surgical Outcomes were compared between cases that had trainee orconsultant listed as primary operator.

Results:one hundred and twenty-two cases were included. Fifty-two cases were operated by a trainee, 68 by a consultant (2 cases undeterminable and excluded). Infant demographics, clinical characteristics and duration of f ollow-up were similarbetween groups. All infants survived to discharge. C ases operated by a trainee andconsultant as primary operator had a similar incidence of postoperative pneumothorax (trainee 4 vs consultant 3; p=0.46), anastomotic leak (5vs 3; p=0.29) and recurrentTOF (0vs 2; p=0.5). Overall 52% of cases had an anastomotic dilatation during follow-up with no difference between trainee and consultant groups (50%vs 53%;p=0.85).

Conclusion: surgical outcomes for repair of OA/TOF are not adversely affected by trainee operating. Trainees with a ppropriate skills should perform supervised OA/TOF repair. These data are important for understanding the inter-relationship between provision of training and surgical outcomes

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Accepted/In Press date: 8 March 2020
e-pub ahead of print date: 1 September 2020

Identifiers

Local EPrints ID: 438878
URI: http://eprints.soton.ac.uk/id/eprint/438878
ISSN: 0035-8843
PURE UUID: 29d13137-49b6-4574-8888-f0648415a0ea
ORCID for Nigel Hall: ORCID iD orcid.org/0000-0001-8570-9374

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Date deposited: 26 Mar 2020 17:30
Last modified: 13 Dec 2021 03:06

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Contributors

Author: Nigel Hall ORCID iD
Author: Ceri E. Jones
Author: R Smyth
Author: S Keys
Author: M Stanton
Author: L. Kitteringham
Author: R.A. Wheeler

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