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Updated: Jul 13, 2025
Robotic D3 Partial Duodenal Resection with Primary Side-to-Side Anastomosis
Published on: December 15, 2023
Association of Age at Duodenal Atresia Repair With Outcomes: A Pediatric NSQIP Analysis
Shale J Mack1, Devon J Pace2, Sanath Patil1
1Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
Insights
Delaying duodenal atresia (DA) repair in premature neonates does not reduce postoperative morbidity. While delayed repair increased ventilation needs, overall surgical outcomes remained similar, suggesting early repair may be suitable for some premature infants.
Area of Science:
- Pediatric Surgery
- Neonatal Surgery
- Gastrointestinal Surgery
Background:
- Neonates with duodenal atresia (DA) often require surgical repair.
- Premature infants with DA typically face worse outcomes.
- The optimal timing for DA repair in premature neonates remains debated.
Purpose of the Study:
- To evaluate the association between the timing of DA repair and postoperative morbidity in neonates.
- To determine if delaying surgery in premature neonates with DA mitigates increased risks.
Main Methods:
- Retrospective analysis of neonates undergoing DA repair from 2015-2020 using the National Surgical Quality Improvement Program-Pediatric database.
- Multivariable regression to identify factors associated with composite morbidity, including corrected gestational age (cGA) and days of life (DOL) at surgery.
- Propensity score matched analysis comparing early (<7 DOL) versus delayed (≥7 DOL) repair in premature neonates (≤35 weeks gestation).
Main Results:
- A total of 809 neonates were included; 35.23% were born at ≤35 weeks gestation.
- Increasing cGA at surgery correlated with decreased morbidity, while increasing DOL at surgery correlated with increased morbidity.
- In premature neonates, delayed repair was linked to longer postoperative ventilation (6 vs. 2 days, p < 0.05), but no significant differences in composite or surgical morbidity were observed compared to early repair.
Conclusions:
- Postoperative morbidity in neonates with DA born at ≤35 weeks cGA is largely driven by non-surgical factors.
- Delaying DA repair does not appear to reduce the risks associated with prematurity.
- Consideration of DA repair around 33-34 weeks gestation may be reasonable for neonates without prohibitive risk factors, balancing surgical timing with prematurity risks.
Purpose:
Neonates with duodenal atresia (DA) are often born prematurely and undergo repair soon after birth, while others are delayed to allow for growth until closer to term corrected gestational age (cGA). Premature infants have been demonstrated to experience worse outcomes, but it is unclear whether delaying surgery mitigates the increased morbidity. This study evaluates the association of timing of DA repair with postoperative morbidity.
Methods:
We retrospectively evaluated neonates undergoing DA repair from the National Surgical Quality Improvement Program-Pediatric database (2015-2020). A multivariable regression analyzed factors associated with composite morbidity, including cGA and age in days of life (DOL) at surgery. A propensity score matched analysis was completed in premature neonates born at ≤35 weeks gestation to compare outcomes at similar birth gestational ages (bGA) and birth weight who underwent early (<7 DOL) versus delayed (≥7 DOL) repair.
Results:
809 neonates were included with a median bGA of 36 weeks (IQR 34-38), birth weight of 2.46 kg (IQR 1.96-2.95), and DOL at surgery of 2 (IQR 1-5). Infants born ≤35 weeks represented 35.23% of the cohort. On multivariable analysis, increasing cGA at surgery was associated with decreased morbidity (OR: 0.91, CI [0.84, 0.99]), and increasing DOL at surgery was associated with increased morbidity (OR: 1.02, CI [1.00, 1.04]). On propensity score matched analysis, delayed repairs were associated with increased postoperative ventilation (6 days vs. 2 days, p < 0.05); however, there were no differences in composite or surgical morbidity between early and delayed repairs.
Conclusions:
Morbidity after DA repair in neonates ≤35 weeks cGA is primarily driven by non-surgical causes, but delaying surgery does not appear to mitigate the risks associated with prematurity. It seems reasonable to consider repair in neonates around 33-34 weeks gestation without prohibitive risk factors. Optimal timing of DA repair requires a delicate balance between these factors.
Level Of Evidence:
Level III.
Type Of Study:
Retrospective Cohort Study.
