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Predictors of Mortality after Primary Discharge from Hospital in Patients with Esophageal Atresia
Sharman P Tan Tanny1, Edward Fearon2, Alisa Hawley3
1Department of Pediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia; F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia.
Insights
Esophageal atresia mortality is 13.5%, with most deaths occurring before hospital discharge. Respiratory issues and associated syndromes are key factors, necessitating careful parental counseling regarding post-discharge risks.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Anomalies
Background:
- Esophageal atresia (EA) is a complex congenital anomaly with significant mortality.
- Understanding mortality patterns is crucial for improving patient outcomes and parental guidance.
Purpose of the Study:
- To describe esophageal atresia mortality rates in a large cohort.
- To identify factors associated with mortality in EA patients.
Main Methods:
- Retrospective analysis of 650 EA patients managed at The Royal Children's Hospital, Melbourne (1980-2018).
- Data included demographics, VACTERL associations, and mortality risk factors.
- Mortality was categorized as before or after hospital discharge.
Main Results:
- Overall mortality was 13.5% (88/650).
- Mortality before discharge (75%) was primarily due to respiratory anomalies and associated syndromes (e.g., Trisomy 18).
- Mortality after discharge (25%) was linked to respiratory compromise and sudden unexplained deaths.
Conclusions:
- Identified predictors of mortality in esophageal atresia.
- Emphasized the need for appropriate parental counseling regarding post-discharge mortality risks.
Objective:
To describe esophageal atresia mortality rates and their associations in our cohort.
Study Design:
Patients with esophageal atresia, managed at The Royal Children's Hospital, Melbourne (1980-2018), who subsequently died, were retrospectively identified from the prospective Nate Myers Oesophageal Atresia database. Data collected included patient and maternal demographics, vertebral anomalies, anorectal malformations, cardiovascular anomalies, tracheoesophageal fistula, renal anomalies, and limb defects (VACTERL) associations, mortality risk factors, and preoperative, operative, and postoperative findings. Mortality before discharge was defined as death during the initial admission.
Results:
A total of 88 of the 650 patients (13.5%) died during the study period; mortality before discharge occurred in 66 of the 88 (75.0%); mortality after discharge occurred in 22 of the 88 (25.0%). Common causes of mortality before discharge were palliation for respiratory anomalies (15/66 [22.7%]), associated syndromes (11/66 [16.7%]), and neurologic anomalies (10/66 [15.2%]). The most common syndrome leading to palliation was trisomy 18 (7/66 [10.6%]). Causes of mortality after discharge had available documentation for 17 of 22 patients (77.3%). Common causes were respiratory compromise (6/17 [35.3%]), sudden unexplained deaths (6/17 [35.3%]), and Fanconi anemia (2/17 [11.8%]). Of the patients discharged from hospital, 22 of 584 (3.8%) subsequently died. There was no statistical difference in VACTERL association between mortality before discharge (31/61 [50.8%]) and mortality after discharge (11/20 [55.0%]), nor in incidence of twins between mortality before discharge (8/56 [14.3%]) and mortality after discharge (2/18 [11.1%]).
Conclusions:
We identified predictors of mortality in patients with esophageal atresia in a large prospective cohort. Parents of children with esophageal atresia must be counselled appropriately as to the likelihood of death after discharge from hospital.
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