ORIGINAL ARTICLES

Esophageal atresia and tracheoesophageal fistula: A retrospective review from a tertiary care institute

Partha Chakraborty¹, Sourav Roy¹, Kartik Chandra Mandal², Pankaj Kumar Halder¹, Gunadhar Jana³, Kallol Paul⁴

¹ Department of Pediatric Surgery, R. G. Kar Medical College, Kolkata, West Bengal, India
² Department of Pediatric Surgery, Dr. B. C. Roy, Post Graduate Institute of Pediatric Sciences (PGIPS), Kolkata, West Bengal, India
³Department of Anesthesiology, K. P. C. Medical College, Jadavpur, Kolkata, West Bengal, India
⁴Department of Pediatric Medicine, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India

Correspondence Address:
Dr. Pankaj Kumar Halder
Saroda Pally, Baruipur, Kolkata - 700144, West Bengal India

Source of Support: None
Conflict of Interest: None

Background: A survey of neonates with esophageal atresia and tracheoesophageal fistula (EA ± TEF) to determine additional factors responsible for poor surgical outcomes in our institution where employing an improved standard of care can ameliorate the outcome.

Materials and Methods: We carried out a retrospective review of 54 neonates, who underwent surgical repair of EA± TEF over a 5-year period. We collected data regarding the patients’ demographics, perioperative findings, records of neonatal intensive care, and ascertained the effects of gender, gestational age, birth weight, age at operation, type of anomaly, coexisting major anomalies, preoperative inotrope therapy, and duration of postoperative ventilation on the surgical outcome.

Results: The mortality rate was 51.9%, out of which, 42.8% of neonates succumbed to ventilator-associated conditions. Age at the time of surgery, gestational age, preoperative inotrope support, presence of coexisting anomalies, and duration of postoperative ventilation were determined as the significant variables predicting mortality(P < 0.05). The area under the Receiver Operating Curve showed the duration of postoperative ventilation as the best indicator of mortality. The Logistic regression model (χ2 = 11.204, P = 0.019) with the above-mentioned variables showed that neonates who were operated before 2.5 days and who required <74.5 hours of postoperative ventilation were 3.91 and 48.30 times more likely to survive respectively, than their counterparts.

Conclusion: A delay in surgery due to delayed diagnosis and or delayed transportation to tertiary centres and prolonged ventilatory support have an additional detrimental effect on the surgical outcomes of EA ± TEF.