Perioperative management and outcomes of esophageal atresia and tracheoesophageal fistula.
BACKGROUND/PURPOSE: Esophageal atresia/tracheoesophageal fistula (EA/TEF) is a rare congenital anomaly lacking contemporary data detailing patient demographics, medical/surgical management and outcomes. Substantial variation in the care of infants with EA/TEF may affect both short- and long-term outcomes. The purpose of this study was to characterize the demographics, management strategies and outcomes in a contemporary multi-institutional cohort of infants diagnosed with EA/TEF to identify potential areas for standardization of care.
METHODS: A multi-institutional retrospective cohort study of infants with EA/TEF treated at 11 children's hospitals between 2009 and 2014 was performed. Over the 5year period, 396 cases were identified in the 11 centers (7±5 per center per year). All infants with a diagnosis of EA/TEF made within 30days of life who had surgical repair of their defect defined as esophageal reconstruction with or without ligation of TEF within the first six months of life were included. Demographic, operative, and outcome data were collected and analyzed to detect associations between variables.
RESULTS: Prenatal suspicion or diagnosis of EA/TEF was present in 53 (13%). The most common anatomy was proximal EA with distal TEF (n=335; 85%) followed by pure EA (n=27; 7%). Clinically significant congenital heart disease (CHD) was present in 137 (35%). Mortality was 7.5% and significantly associated with CHD (p
CONCLUSION: Contemporary treatment of EA/TEF is characterized by substantial variation in perioperative management and considerable postoperative morbidity and mortality. Future studies are planned to establish best practices and clinical care guidelines for infants with EA/TEF.
LEVEL OF EVIDENCE: Type of study: Treatment study. Level IV.
Journal of pediatric surgery
Abnormalities, Multiple; Anastomotic Leak; Bronchoscopy; Esophageal Atresia; Esophagoplasty; Female; Humans; Infant; Infant, Newborn; Male; Perioperative Care; Postoperative Complications; Retrospective Studies; Trachea; Tracheoesophageal Fistula; Treatment Outcome
Anastomotic leak; Anastomotic stricture; Esophageal atresia; Tracheoesophageal stricture; Variability in care; Babies
Lal, Dave R.; Gadepalli, Samir K.; Downard, Cynthia D.; Ostlie, Daniel J.; Minneci, Peter C.; Swedler, Ruth M.; Chelius, Thomas; Cassidy, Laura; Rapp, Cooper T.; Deans, Katherine J.; Fallat, Mary E.; Finnell, S Maria E.; Helmrath, Michael A.; Hirschl, Ronald B.; Kabre, Rashmi S.; Leys, Charles M.; Mak, Grace; Raque, Jessica; Rescorla, Frederick J.; Saito, Jacqueline M.; St Peter, Shawn D.; von Allmen, Daniel; Warner, Brad W.; Sato, Thomas T.; and Midwest Pediatric Surgery Consortium, "Perioperative management and outcomes of esophageal atresia and tracheoesophageal fistula." (2017). Manuscripts, Articles, Book Chapters and Other Papers. 431.