Factors Predictive of a Poor Outcome in Patients with Esophageal Atresia

Abstract

Purpose: Despite a major improvement in the survival rate of patients with esophageal atresia and tracheoesophageal fistula (EA-TEF), the morbidity associated with this condition remains high. Given this, the aim of our study was to identify early predictive factors of serious complications during the 1st year of life (short term) and after 1 year of age (long term) in these patients. Methods: We retrospectively reviewed the charts of all EA-TEF children born between January 1990 and May 2005. Included cases had been followed at Hopital Sainte-Justine for a minimum of one year. Variables analyzed included different patient characteristics, details of the surgery and early post-operative period. A complicated evolution was defined as the occurrence of at least one of severe gastroesophageal reflux, esophageal stricture needing dilatation, recurrent fistula needing surgery, need for gavage feeding for ≥ 3 months, esophageal foreign body impaction needing endoscopic removal, severe tracheomalacia, chronic respiratory disease and death. Results: 152 EA-TEF patients fulfilled our inclusion criteria. 47% were female. Mean gestational age was 36.8 weeks (24–42 wks) and mean birth weight was 2515 g (555–4334 g). 47% had a complicated evolution before one year of age and 45% after one year. Multiple logistic regression demonstrated in the first year of life, 4 groups of significant variables (P≤ 0.05) associated with a complex evolution: Surgery associated issues (long gap, 2 step surgery, Foker, initial gastrostomy, anastomotic leak))[OR 5.4; 95% CI 1.7–17], Post-op respiratory complications (pneumothorax, intubation ≥ 5 days p-op, chylothorax) [OR 4.4; 95% CI 1.6–12], Post-op feeding difficulties (Inability to feed orally, need for gavage feeding or gastrostomy) [OR 2.6; 95% CI 1.1–6.1], “other” malformation not related to VACTERL [OR 2.2; 95% CI 1.0–5.0]. After one year of age, only the surgery associated issues[ OR 2.8; 95% CI 1.4–5.9] and a complicated evolution in the first year of life were predictive of a continued complicated evolution [OR 3.6; 95% CI 1.4–9.2]. Conclusion: In children with EA-TEF, we found a number of variables predictive of a high risk of morbidity during the first year of life. Using these variables to identify EA-TEF children at higher risk of complications will allow us to modify their medical management and hopefully reduce their long term morbidity.