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Multicenter Study
. 2014 Aug;156(2):483-91.
doi: 10.1016/j.surg.2014.03.016. Epub 2014 Mar 14.

Morbidity and mortality in patients with esophageal atresia

Jason P Sulkowski  1 , Jennifer N Cooper  2 , Joseph J Lopez  2 , Yamini Jadcherla  2 , Alissabeth Cuenot  2 , Peter Mattei  3 , Katherine J Deans  1 , Peter C Minneci  4
Affiliations
Multicenter Study

Morbidity and mortality in patients with esophageal atresia

Jason P Sulkowski et al. Surgery. 2014 Aug.

Abstract

Background: This study reports national estimates of population characteristics and outcomes for patients with esophageal atresia with or without tracheoesophageal fistula (EA/TEF) and evaluates the relationships between hospital volume and outcomes.

Methods: Patients admitted within 30 days of life who had International Classification of Diseases, 9th Edition, Clinical Modification diagnosis and procedure codes relevant to EA/TEF during 1999-2012 were identified with the Pediatric Health Information System database. Baseline demographics, comorbidities, and postoperative outcomes, including predictors of in-hospital mortality, were examined up to 2 years after EA/TEF repair.

Results: We identified 3,479 patients with EA/TEF treated at 43 children's hospitals; 37% were premature and 83.5% had ≥1 additional congenital anomaly, with cardiac anomalies (69.6%) being the most prevalent. Within 2 years of discharge, 54.7% were readmitted, 5.2% had a repeat TEF ligation, 11.4% had a repeat operation for their esophageal reconstruction, and 11.7% underwent fundoplication. In-hospital mortality was 5.4%. Independent predictors of mortality included lower birth weight, congenital heart disease, other congenital anomalies, and preoperative mechanical ventilation. There was no relationship between hospital volume and mortality or repeat TEF ligation.

Conclusion: This study describes population characteristics and outcomes, including predictors of in-hospital mortality, in EA/TEF patients treated at children's hospitals across the United States. Across these hospitals, rates of mortality or repeat TEF ligation were not dependent on hospital volume.

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Figures

Figure 1
Figure 1. Effects of birth weight and race on mortality
There was a significant quantitative interaction between birth weight and race (p<0.05). In infants less than 2000 grams, black patients showed a greater decrease in their mortality risk for every 100 gram increase in birth weight (OR (95% CI); 0.82 (0.76, 0.88), p=0.02) than white patients (0.89 (0.87, 0.92), p<.0001) or patients of other or unknown race (0.88 (0.84, 0.93), p=0.04). In infants over 2,000 grams, these racial differences do not persist.
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