Association of institutional case volume and children's surgery verification with morbidity/mortality in neonatal duodenal atresia repair: A multi-institutional cohort study

Background: Duodenal atresia (DA) is a congenital malformation of the gastrointestinal tract requiring surgical repair in the neonatal period. This study aims to evaluate the impact of both institutional case volume and American College of Surgeons (ACS) Children's Surgery Verification (CSV) status on surgical outcomes of DA repair. Methods: This retrospective multicenter cohort study analyzed neonates (0–28 days) undergoing DA repair using ACS National Surgical Quality Improvement Program-Pediatric data from January 2016 to December 2022. The effects of relative institutional volume tertiles and CSV status on composite morbidity/mortality was assessed via hierarchical multivariate modeling with mixed effects. Results: In the study period 863 neonates underwent DA repair across 135 institutions. Composite morbidity/mortality occurred in 83 (9.7 %) patients; In multivariate analysis institutional volume tertiles did not significantly affect composite morbidity/mortality. In contrast, operations performed at non-CSV-verified hospitals had significantly higher odds of composite morbidity/mortality (OR: 2.62, 95 % CI: 1.39, 4.91). Conclusions: In this multi-center retrospective study, CSV status was associated with improved outcomes in neonatal DA repairs while institutional volume was not. Further research should elucidate the elements of verification which most contribute to these improved outcomes.