Resource use in infants undergoing esophageal atresia repair at major children's hospitals

Esophageal atresia with or without tracheoesophageal fistula is a resource-intensive neonatal surgical condition; however, the magnitude of the institutional cost burden is not well understood. In this study, we used a national database to measure resource use associated with the initial management of esophageal atresia at major children's hospitals nationwide.

The Pediatric Health Information System database was queried for infants undergoing esophageal atresia repair at 1 of 47 children's hospitals in the United States between 2014 and 2021. Those undergoing concomitant cardiac surgery were excluded. The primary outcome measure was total adjusted cost (in US dollars) during the index hospitalization. Multivariable linear regression analyses were performed (P < .05).

Of 1,346 infants with esophageal atresia who were identified, 993 (73.8%) met inclusion criteria. The median cost per patient was $545,000 (interquartile range, $302,000-$1,130,000). Room charges (median $391,000; interquartile range, $219,000-$841,000) accounted for nearly three-quarters of total costs. There was no correlation between institutional surgical volume and hospital cost. Long-gap disease (β: 867.3, P < .0001) was the most significant preoperative factor associated with increased hospital cost. The major postoperative events associated with increased cost were mechanical ventilation days (β: 17.7, P < .0001), pneumonia (β: 168.6, P = .006), and anastomotic leak (β: 137.2, P = .003).

In this multicenter cohort study, the median cost associated with the surgical management of a newborn with esophageal atresia exceeded a half a million dollars. The development of esophageal atresia-specific clinical practice guidelines aimed at reducing postoperative respiratory morbidity and anastomotic leak rates may be useful to minimize the resource burden associated with the care of these challenging patients.