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Esophageal atresia with tracheoesophageal fistula and early postoperative mortality
Talal A Al-Malki1, Ashraf H Ibrahim
1College of Medicine & Medical Sciences, Taif University-Taif and Department of Pediatric Surgery, Aseer Central Hospital, Abha, Saudi Arabia. taam_tm@yahoo.com
Insights
Sepsis and technical issues were the primary causes of early death in infants with esophageal atresia (EA) and tracheoesophageal fistula (TEF). Early identification of factors like pneumonia and sepsis is crucial for improving survival rates in these complex congenital conditions.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Anomalies
Background:
- Associated anomalies are a known cause of mortality in infants with esophageal atresia (EA) and/or tracheoesophageal fistula (TEF).
- This study identifies additional significant causes of early postoperative mortality in EA/TEF cases.
- Preoperative classifications predicting mortality were also evaluated for comparison.
Purpose of the Study:
- To determine the major causes of early postoperative mortality in infants with EA and/or TEF.
- To compare the effectiveness of existing mortality prediction classifications.
Main Methods:
- A retrospective review of 101 infant charts with EA and/or TEF from 1990-2000.
- Identification of morbidity and causes of postoperative mortality during initial hospitalizations.
- Classification of patients using Waterston, Montreal, and Spitz systems.
Main Results:
- Mortality rate was 30.7% (31 out of 101 patients).
- Avoidable causes included primary sepsis (32.3%), technical issues (25.8%), and severe pneumonia (16.1%).
- Unavoidable causes were major congenital anomalies (19.3%) and life-incompatible anomalies (6.5%).
Conclusions:
- Primary sepsis and sepsis from technical problems were the leading causes of mortality.
- Predictive factors for mortality included pneumonia/sepsis at presentation or acquired, major anomalies, long gaps, and leaks.
- The Waterston classification demonstrated the best statistical applicability in this series.
Background:
Several recent reports showed that associated anomalies represent the main cause of postoperative mortality in infants born with esophageal atresia (EA) and/ or tracheoesophageal fistula (TEF) Our observations present additional causes of mortality to the above mentioned. The aim of this study is to identify the major causes of early postoperative mortality in cases of EA and/or TEF in our setup. The ongoing preoperative classifications predicting mortality will be also used for comparison.
Patients And Methods:
We reviewed 101 charts of all cases with EA and/or TEF in a period of 11 years from 1990 to 2000. Morbidity and causes of postoperative mortality during the first admissions were identified. The factors predicting mortality were documented. Patients were classified according to Waterston, Montreal and Spitz classifications.
Results:
Thirty-one patients (30.7%) died. Two main groups of post operative mortality were identified. The first group included the possibly avoidable causes of mortality which were primary sepsis (n=10, 32.3%), technical problems (n=8, 25.8%) and severe pneumonia (n=5, 16.1%). The unavoidable causes of mortality included major congenital anomalies (n=6, 19.3%) and anomalies incompatible with life (n=2, 6.5%).
Conclusion:
Primary sepsis and sepsis due to technical problems were the main causes of mortality in our series. Factors predicting mortality were pneumonia at presentation, sepsis at presentation or that acquired during hospitalization, major or life threatening anomalies, long gaps and major leaks. The Waterston classification was statistically the best applicable in this study.
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