139. DOES POSTOPERATIVE NON-INVASIVE VENTILATION INCREASE THE RISK FOR COMPLICATIONS IN CHILDREN POST-REPAIR OF ESOPHAGEAL ATRESIA?

Abstract

Abstract The primary aim of this study was to determine if postoperative use of high flow nasal cannula (HFNC) and/or continuous positive airway pressure (CPAP) are independent risk factors for adverse postoperative outcomes after surgical repair of Esophageal Atresia (EA). Secondary aims were to determine other significant clinical risk factors associated with these adverse outcomes. A retrospective chart review was conducted on all EA neonates repaired and managed postoperatively between 2007-2020 across two centres: Sydney Children’s Hospital (SCH) and The Royal Hospital for Women (RHW). The primary outcome measure was anastomotic leakage (AL), and other outcome measures included anastomotic stricture (AS), mediastinitis, sepsis, and pneumothorax. Significant associations were identified using Chi-square, and univariate and multivariate logistical regression models (p < 0.05). We reviewed 104 charts. Post-repair, all were placed on invasive mechanical ventilation (IMV) (median of 119.50 hours). Of these, 45 (43.3%) were subsequently bridged with some form of NIV post-extubation, with 33 each on HFNC and CPAP. 59 (56.7%) developed at least one postoperative complication: 12 had AL, and 17 had AS. After adjustment, no significant association was found between HFNC or CPAP use with development of AL (p = 0.074 and p = 0.859), or any other adverse outcome. Independent risk factors for AL include anastomosis under tension and type B EA. Delayed first oral intake significantly increased risk of mediastinitis and sepsis. Our results show no increased risk of AL or any other adverse postoperative event with use of non-invasive ventilation in form of HFNC and/or CPAP. Reducing anastomotic tension during primary repair of OA-TOF and introducing early oral feeding appears to be protective and reduces risk of AL and infection. However, further prospective research is still needed to help guide post extubation ventilation strategies in this population.