P2.P311: Care of Children with Esophageal Atresia Following Initial Repair Is Increasingly Concentrated at a Few Centers

Background: The management of esophageal atresia has traditionally been uniformly distributed across Children’s Hospitals in the United States. The development of specialized centers for treating comorbidities of esophageal atresia and its postoperative complications may alter referral patterns for subsequent care. We hypothesize that secondary care for esophageal atresia is increasingly being concentrated at a few centers in the United States.

Methods: The Pediatric Health and Information System (PHIS) was queried for patients admitted between 2004-2023 with an ICD-10 diagnosis code for congenital esophageal anomaly and a CPT or ICD-10-PCS code for a surgical intervention during the same admission. Surgical cases performed on the same patient within 6 months of a previous intervention were excluded from analysis. Hospitals were excluded if complete data were not available. Hospitals with available data for the duration of the study were stratified into quartiles based on total number of esophageal cases performed.

Results: There were 4,338 esophageal cases performed during the analysis period at 33 different pediatric hospitals, 680 (15.7%) of which were secondary cases, defined as a surgical intervention in a patient 1 month or older at time of admission. There were significant differences in total number of primary repairs of esophageal atresia performed between quartiles—with the following case volumes in each quartile 1st:402, 2nd:581, 3rd:860, and 4th:1193 (p < 0.001). However, there was no significant change in the numbers of primary repairs year over year between quartiles (p= 066,Figure 1). There were significant differences in total number of secondary repairs within each quartile—with the following case volumes in each quartile 1st:27, 2nd:49, 3rd:121, and 4th:416 (p < 0.001). Additionally, there was a significant change in the number of secondary repairs year over year between quartiles, largely driven by an average yearly growth rate of 38.9% in the top quartile (p < 0.01,Figure 1).

Conclusion: The number of newborns who undergo primary esophageal atresia repair has remained constant at Children’s Hospitals over time. However, the care of children who require subsequent care for esophageal atresia beyond the newborn period appears to be increasingly concentrated in only a few centers. This trend has implications for equitable patient access and for training of future pediatric surgeons.