Long-Term Aerodigestive Morbidities After Esophageal Atresia/Tracheoesophageal Fistula Repair

Abstract

Purpose: Short-term complications, such as gastroesophageal reflux disease (GERD) and anastomotic stricture, are well documented in esophageal atresia/tracheoesophageal fistula (EA/TEF) survivors; however, long-term aerodigestive morbidities remain poorly understood. This study evaluated the long-term aerodigestive morbidities of EA/TEF survivors through propensity-matched analysis using a large international electronic health record (EHR) database.

Methods: EA/TEF cases from 2004 to 2024 were identified in the TriNetX EHR database, which encompasses over 100 million patients from 86 international healthcare organizations. Cases were identified using the International Classification of Disease (ICD) 9/10 codes and compared with a matched control group based on age, race, ethnicity, and sex. Outcomes were analyzed using the chi-square test and Kaplan-Meier morbidity curves, and subgroup analysis was used to assess differences in patients with and without congenital heart disease (CHD).

Results: Among the 5368 identified patients with EA/TEF, 5052 were included in the analysis (median age, 13 years; interquartile range: 8-18 years). EA/TEF survivors had significantly higher rates of asthma (28 % vs. 9 %, p < 0.0001), tracheomalacia (29 % vs. 0 %, p < 0.001), pneumonia (31 % vs. 11 %, p < 0.001), obstructive sleep apnea (OSA) (13 % vs. 2 %, p < 0.001), GERD (50 % vs. 5 %, p < 0.001), esophageal dyskinesia (8 % vs. 0 %, p < 0.001), esophageal stricture (32 % vs. 0 %, p < 0.001), and esophageal dilations (15 % vs. 0 %, p < 0.001) than controls did. Moreover, there was increasing divergence (p < 0.001) of combined aerodigestive morbidity rates between the EA/TEF and control groups over long-term follow up. CHD emerged as an independent risk factor for increased esophageal and respiratory morbidity (p < 0.001).

Conclusion: These findings underscore the significant long-term aerodigestive morbidities in EA/TEF survivors, particularly those with CHD, highlighting the need for lifelong surveillance and targeted management to improve outcomes in this high-risk population.

Type of study: Retrospective Comparative Study.

Level of evidence: Level III.

Keywords: Congenital heart disease; Esophageal atresia/tracheoesophageal fistula; Obstructive sleep apnea; Pediatric surgery; Propensity-matched analysis; Respiratory complications.