An analysis of early nonmortality outcome prediction in esophageal atresia

Advances in care for neonates with esophageal atresia (EA) has improved overall survival rates. Disease-specific prognostic scores for EA assess mortality risk without assessing patient morbidity. We undertook an analysis of these and generic scoring systems evaluating their ability to predict early nonmortality outcomes.

We conducted a retrospective review of all patients with EA at our tertiary care children's hospital. Disease-specific (Spitz, Waterston, and Montreal) and generic prognostic scores (Score for Neonatal Acute Physiology II and Score for Neonatal Acute Physiology-Perinatal Extension) were calculated. Outcomes investigated included mortality and early nonmortality outcomes (leak, stricture, and recurrent fistula). These were assessed individually and as a composite "poor outcome" score. Correlations were sought, and receiver operating characteristic curves were generated.

Fifty patients were included for analysis, with 5 deaths (10%) in our series. Eight patients developed a postoperative leak, 18 developed stenosis requiring dilatation, and 2 developed refistulization. Overall, 51% of survivors had a poor composite outcome. Although no prognostic score achieved statistical significance, the generic scores outperformed the disease-specific scores in predicting early nonmortality outcomes.

Postoperative morbidity remains common in patients with EA. Disease-specific, preexisting prognostic scoring systems do not delineate surviving patients at risk for early complications and appears to underperform when compared with generic prognostic scores.