Your browser doesn't support javascript.
loading
Worth the Wait? The Impact of Timing of Repair of Esophageal Atresia With Tracheoesophageal Fistula on Outcomes.
Patwardhan, Utsav; West, Erin; Ignacio, Romeo C; Gollin, Gerald.
Afiliación
  • Patwardhan U; Rady Children's Hospital San Diego, Division of Pediatric Surgery, 3020 Children's Way, San Diego, CA 92123, USA; Naval Medical Center San Diego, Department of Surgery, 34800 Bob Wilson Drive, San Diego, CA 92134, USA.
  • West E; Naval Medical Center San Diego, Department of Surgery, 34800 Bob Wilson Drive, San Diego, CA 92134, USA.
  • Ignacio RC; Rady Children's Hospital San Diego, Division of Pediatric Surgery, 3020 Children's Way, San Diego, CA 92123, USA; University of California San Diego School of Medicine, Department of Surgery, 9500 Gilman Dr, La Jolla, CA 92093, USA.
  • Gollin G; Rady Children's Hospital San Diego, Division of Pediatric Surgery, 3020 Children's Way, San Diego, CA 92123, USA; University of California San Diego School of Medicine, Department of Surgery, 9500 Gilman Dr, La Jolla, CA 92093, USA. Electronic address: ggollin@rchsd.org.
J Pediatr Surg ; : 161680, 2024 Aug 16.
Article en En | MEDLINE | ID: mdl-39261185
ABSTRACT

INTRODUCTION:

Infants with esophageal atresia and tracheoesophageal fistula (EA/TEF) are at increased risk for respiratory compromise and gastric perforation until fistula ligation. We sought to describe current practice regarding the timing of EA/TEF repair and hypothesized that age at repair is a predictor of adverse outcomes.

METHODS:

The Pediatric Health Information System (PHIS) database was used to identify patients with EA/TEF who underwent fistula ligation and esophago-esophagostomy at US children's hospitals from July 2016-June 2021. Patients with a repair >10 days of age, a long-gap atresia, or H-type fistula were excluded. Comorbidities including prematurity and operative congenital heart disease were noted. Outcomes including anastomotic leak, gastric perforation, and post-operative respiratory failure were assessed for association with age and day of the week of operation.

RESULTS:

Among 863 patients that were evaluated, the plurality of operations was on DOL 2 (36%) and 83% were on a weekday (random rate = 71%). Later operations had shorter LOS (p = 0.04) and more recurrent nerve injuries (p = 0.01). Weekend repairs were associated with equivalent outcomes. Gastric perforations occurred in 18 (2.0%) patients; 11 (61%) of these occurred after DOL 2.

CONCLUSIONS:

We found no significant differences in outcomes other than more recurrent nerve injury and decreased LOS with EA/TEF repair at older ages. Although repair beyond DOL 2 was safe from a respiratory standpoint, most gastric perforations occurred after this point. In the absence of contraindications or significantly reduced weekend capabilities, we recommend repair of EA/TEF by DOL 2. LEVEL OF EVIDENCE III.
Palabras clave
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Pediatr Surg Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Pediatr Surg Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos