Perioperative management and outcomes of esophageal atresia and tracheoesophageal fistula

Dave R. Lal, Samir K. Gadepalli, Cynthia D. Downard, Daniel J. Ostlie, Peter C. Minneci, Ruth M. Swedler, Thomas Chelius, Laura Cassidy, Cooper T. Rapp, Katherine J. Deans, Mary E. Fallat, S. Maria Finnell, Michael A. Helmrath, Ronald B. Hirschl, Rashmi S. Kabre, Charles M. Leys, Grace Mak, Jessica Raque, Frederick Rescorla, Jacqueline M. SaitoShawn D. St. Peter, Daniel von Allmen, Brad W. Warner, Thomas T. Sato

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

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 5. year 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 30. days 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 . <. 0.0001). Postoperative morbidity occurred in 62% of the population, including 165 (42%) cases with anastomotic stricture requiring intervention, anastomotic leak in 89 (23%), vocal cord paresis/paralysis in 26 (7%), recurrent fistula in 19 (5%), and anastomotic dehiscence in 9 (2%). Substantial variation in practice across our institutions existed: bronchoscopy prior to repair was performed in 64% of cases (range: 0%-100%); proximal pouch contrast study in 21% (0%-69%); use of interposing material between the esophageal and tracheal suture lines in 38% (0%-69%); perioperative antibiotics ≥. 24. h in 69% (36%-97%); and transanastomotic tubes in 73% (21%-100%). 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.

Original languageEnglish (US)
JournalJournal of Pediatric Surgery
DOIs
StateAccepted/In press - Aug 15 2016

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Infant Care
Vocal Cord Paralysis
Demography
Heart Diseases
Morbidity
Anastomotic Leak
Mortality
Esophageal atresia with or without tracheoesophageal fistula
Bronchoscopy
Practice Guidelines
Sutures
Fistula
Ligation
Anatomy
Pathologic Constriction
Cohort Studies
Retrospective Studies
Guidelines
Anti-Bacterial Agents
Population

Keywords

  • Anastomotic leak
  • Anastomotic stricture
  • Esophageal atresia
  • Tracheoesophageal stricture
  • Variability in care

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

Cite this

Lal, D. R., Gadepalli, S. K., Downard, C. D., Ostlie, D. J., Minneci, P. C., Swedler, R. M., ... Sato, T. T. (Accepted/In press). Perioperative management and outcomes of esophageal atresia and tracheoesophageal fistula. Journal of Pediatric Surgery. https://doi.org/10.1016/j.jpedsurg.2016.11.046

Perioperative management and outcomes of esophageal atresia and tracheoesophageal fistula. / 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; Helmrath, Michael A.; Hirschl, Ronald B.; Kabre, Rashmi S.; Leys, Charles M.; Mak, Grace; Raque, Jessica; Rescorla, Frederick; Saito, Jacqueline M.; St. Peter, Shawn D.; von Allmen, Daniel; Warner, Brad W.; Sato, Thomas T.

In: Journal of Pediatric Surgery, 15.08.2016.

Research output: Contribution to journalArticle

Lal, DR, Gadepalli, SK, Downard, CD, Ostlie, DJ, Minneci, PC, Swedler, RM, Chelius, T, Cassidy, L, Rapp, CT, Deans, KJ, Fallat, ME, Finnell, SM, Helmrath, MA, Hirschl, RB, Kabre, RS, Leys, CM, Mak, G, Raque, J, Rescorla, F, Saito, JM, St. Peter, SD, von Allmen, D, Warner, BW & Sato, TT 2016, 'Perioperative management and outcomes of esophageal atresia and tracheoesophageal fistula', Journal of Pediatric Surgery. https://doi.org/10.1016/j.jpedsurg.2016.11.046
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 ; Helmrath, Michael A. ; Hirschl, Ronald B. ; Kabre, Rashmi S. ; Leys, Charles M. ; Mak, Grace ; Raque, Jessica ; Rescorla, Frederick ; Saito, Jacqueline M. ; St. Peter, Shawn D. ; von Allmen, Daniel ; Warner, Brad W. ; Sato, Thomas T. / Perioperative management and outcomes of esophageal atresia and tracheoesophageal fistula. In: Journal of Pediatric Surgery. 2016.
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title = "Perioperative management and outcomes of esophageal atresia and tracheoesophageal fistula",
abstract = "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 5. year 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 30. days 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 . <. 0.0001). Postoperative morbidity occurred in 62{\%} of the population, including 165 (42{\%}) cases with anastomotic stricture requiring intervention, anastomotic leak in 89 (23{\%}), vocal cord paresis/paralysis in 26 (7{\%}), recurrent fistula in 19 (5{\%}), and anastomotic dehiscence in 9 (2{\%}). Substantial variation in practice across our institutions existed: bronchoscopy prior to repair was performed in 64{\%} of cases (range: 0{\%}-100{\%}); proximal pouch contrast study in 21{\%} (0{\%}-69{\%}); use of interposing material between the esophageal and tracheal suture lines in 38{\%} (0{\%}-69{\%}); perioperative antibiotics ≥. 24. h in 69{\%} (36{\%}-97{\%}); and transanastomotic tubes in 73{\%} (21{\%}-100{\%}). 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.",
keywords = "Anastomotic leak, Anastomotic stricture, Esophageal atresia, Tracheoesophageal stricture, Variability in care",
author = "Lal, {Dave R.} and Gadepalli, {Samir K.} and Downard, {Cynthia D.} and Ostlie, {Daniel J.} and Minneci, {Peter C.} and Swedler, {Ruth M.} and Thomas Chelius and Laura Cassidy and Rapp, {Cooper T.} and Deans, {Katherine J.} and Fallat, {Mary E.} and Finnell, {S. Maria} and Helmrath, {Michael A.} and Hirschl, {Ronald B.} and Kabre, {Rashmi S.} and Leys, {Charles M.} and Grace Mak and Jessica Raque and Frederick Rescorla and Saito, {Jacqueline M.} and {St. Peter}, {Shawn D.} and {von Allmen}, Daniel and Warner, {Brad W.} and Sato, {Thomas T.}",
year = "2016",
month = "8",
day = "15",
doi = "10.1016/j.jpedsurg.2016.11.046",
language = "English (US)",
journal = "Journal of Pediatric Surgery",
issn = "0022-3468",
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TY - JOUR

T1 - Perioperative management and outcomes of esophageal atresia and tracheoesophageal fistula

AU - Lal, Dave R.

AU - Gadepalli, Samir K.

AU - Downard, Cynthia D.

AU - Ostlie, Daniel J.

AU - Minneci, Peter C.

AU - Swedler, Ruth M.

AU - Chelius, Thomas

AU - Cassidy, Laura

AU - Rapp, Cooper T.

AU - Deans, Katherine J.

AU - Fallat, Mary E.

AU - Finnell, S. Maria

AU - Helmrath, Michael A.

AU - Hirschl, Ronald B.

AU - Kabre, Rashmi S.

AU - Leys, Charles M.

AU - Mak, Grace

AU - Raque, Jessica

AU - Rescorla, Frederick

AU - Saito, Jacqueline M.

AU - St. Peter, Shawn D.

AU - von Allmen, Daniel

AU - Warner, Brad W.

AU - Sato, Thomas T.

PY - 2016/8/15

Y1 - 2016/8/15

N2 - 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 5. year 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 30. days 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 . <. 0.0001). Postoperative morbidity occurred in 62% of the population, including 165 (42%) cases with anastomotic stricture requiring intervention, anastomotic leak in 89 (23%), vocal cord paresis/paralysis in 26 (7%), recurrent fistula in 19 (5%), and anastomotic dehiscence in 9 (2%). Substantial variation in practice across our institutions existed: bronchoscopy prior to repair was performed in 64% of cases (range: 0%-100%); proximal pouch contrast study in 21% (0%-69%); use of interposing material between the esophageal and tracheal suture lines in 38% (0%-69%); perioperative antibiotics ≥. 24. h in 69% (36%-97%); and transanastomotic tubes in 73% (21%-100%). 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.

AB - 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 5. year 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 30. days 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 . <. 0.0001). Postoperative morbidity occurred in 62% of the population, including 165 (42%) cases with anastomotic stricture requiring intervention, anastomotic leak in 89 (23%), vocal cord paresis/paralysis in 26 (7%), recurrent fistula in 19 (5%), and anastomotic dehiscence in 9 (2%). Substantial variation in practice across our institutions existed: bronchoscopy prior to repair was performed in 64% of cases (range: 0%-100%); proximal pouch contrast study in 21% (0%-69%); use of interposing material between the esophageal and tracheal suture lines in 38% (0%-69%); perioperative antibiotics ≥. 24. h in 69% (36%-97%); and transanastomotic tubes in 73% (21%-100%). 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.

KW - Anastomotic leak

KW - Anastomotic stricture

KW - Esophageal atresia

KW - Tracheoesophageal stricture

KW - Variability in care

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