Trisomy 21 and postoperative outcomes after esophageal atresia repair: A propensity score matching study

Trisomy 21 (T21) is frequently associated with congenital heart disease and other comorbidities that may influence outcomes following esophageal atresia (EA) repair. The independent effect of T21 on postoperative mortality remains unclear. We sought to evaluate outcomes following EA repair in patients with and without T21.

We conducted a retrospective cohort study using the NSQIP-P database (2012-2020) of patients undergoing EA repair. Primary outcome was 30-day postoperative mortality. Secondary outcomes included postoperative complications, 30-day readmission, reoperation, and length of stay (LOS). Propensity score matching (10:1) balanced cohorts by age, operative weight, cardiac risk factors, and presence of tracheoesophageal fistula. Multivariable logistic regression identified predictors of mortality.

Among 2229 patients, 49 (2.2%) had T21. Compared to non-T21 patients, those with T21 were older at repair (21 vs. 2 days, p < 0.001) and had a longer LOS (30 vs. 20 days, p = 0.008). Rates of reoperation, readmission, and overall complications were similar. After matching, T21 was independently associated with increased 30-day mortality (OR 10.2, 95% CI 2.23-46.75; p = 0.003). Operative weight was also associated with mortality (OR 0.29, 95% CI 0.09-0.94; p = 0.40). Trisomy 21 was not associated with overall complications, but a higher rate of VTE (OR 5.16, 95% CI 1.2-22.24; p = 0.028) was identified in these patients.

Trisomy 21 is a risk factor for 30-day mortality following EA repair. These findings inform perioperative risk stratification and preoperative counseling in this high-risk population.