BACKGROUND: The contemporary frequency of cloaca repairs has not been well-defined, nor has the general volume of repairs per institution over time. Using a national registry of U.S. children’s hospitals, we aimed to characterize trends in cloaca repair over time and by institution. METHODS: Using the Pediatric Health Information System® (PHIS), we identified patients who underwent primary cloacal repair between 2012-2022 using ICD9/10 procedure and diagnosis codes. Age was restricted to <3 years. The abstraction method was verified by cross-referencing the PHIS-identified cases with cases performed at our institution. Average annual percent change was calculated, variation in case counts by institution represented graphically, and cases by institution stratified by year depicted using a bubble plot. RESULTS: During the study period, a cumulative 228 primary cloaca repairs were performed across 49 PHIS hospitals. The median total annual number of repairs was 19 (range 9 - 45), with an average annual percent change of +3% (Figure 1a). The repairs were performed at 37 unique PHIS hospitals. Nearly half the repairs (48%) were performed at four institutions; the remaining institutions individually contributed less than 5% of the total repairs (Figure 1b). The average number of cases across institution ranged between 0-4 per year (overall range 0-12 cases/year). The four higher volume institutions performed an average of 2-4 repairs per year. That said, there was variability in the annual number of repairs across the higher volume institutions over time (Figure 2). CONCLUSIONS: Cloacal reconstruction is rare with most pediatric hospitals in the U.S. performing less than one a year. A large proportion of the procedures is performed by a subset of institutions, yet even at the highest volume locations the number per year is small. The rarity of this condition underscores the essential nature of multidisciplinary care for this complex condition for both surgical reconstruction and longitudinal clinical care.
