BACKGROUND/ PURPOSE: Long gap esophageal atresia may require months of preoperative management before definitive repair. When 2 recent patients prompted the authors to consider preoperative home care, no published protocol could be identified. This survey is undertaken to determine pediatric surgeons' experience with preoperative home care for long gap atresia. METHODS: A total of 543 surgeons were asked if any patients with long gap atresia had been treated preoperatively at home. For patients sent home, information on nursing care, insurance issues, complications, and timing or type of repair was requested. RESULTS: A total of 380 surveys (70%) were returned. A total of 165 surveys representing 348 patients were included. Forty-one of 165 surgeons (25%) treated 63 of 87 patients (72%) with long gap atresia and an intact upper pouch at home. Home nursing care was provided for 44 patients (70%): 16 (36.4%) night shift, 2 (4.5%) day shift, 3 (6.8%) 24 hour, and 23 (52.3%) intermittent care. No complications referable to preoperative home care were reported. CONCLUSIONS: Significant hesitancy and practice variance exists regarding preoperative home care of patients with long gap esophageal atresia. Many surgeons are satisfied with the safety and cost effectiveness of this technique, although a prospective, multicenter trial is needed to study it in a randomized, controlled fashion.
BACKGROUND/ PURPOSE:Long gap esophageal atresia may require months of preoperative management before definitive repair. When 2 recent patients prompted the authors to consider preoperative home care, no published protocol could be identified. This survey is undertaken to determine pediatric surgeons' experience with preoperative home care for long gap atresia. METHODS: A total of 543 surgeons were asked if any patients with long gap atresia had been treated preoperatively at home. For patients sent home, information on nursing care, insurance issues, complications, and timing or type of repair was requested. RESULTS: A total of 380 surveys (70%) were returned. A total of 165 surveys representing 348 patients were included. Forty-one of 165 surgeons (25%) treated 63 of 87 patients (72%) with long gap atresia and an intact upper pouch at home. Home nursing care was provided for 44 patients (70%): 16 (36.4%) night shift, 2 (4.5%) day shift, 3 (6.8%) 24 hour, and 23 (52.3%) intermittent care. No complications referable to preoperative home care were reported. CONCLUSIONS: Significant hesitancy and practice variance exists regarding preoperative home care of patients with long gap esophageal atresia. Many surgeons are satisfied with the safety and cost effectiveness of this technique, although a prospective, multicenter trial is needed to study it in a randomized, controlled fashion.
Authors: Catherine J Hunter; Mikael Petrosyan; Meghan E Connelly; Henri R Ford; Nam X Nguyen Journal: Pediatr Surg Int Date: 2009-12 Impact factor: 1.827