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Long-term medical support after definitive surgery for esophageal atresia: analysis using a national inpatient
Yoshitsugu Yanagida1,2, Shotaro Aso3, Michimasa Fujiogi1
1Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
Insights
Many patients need ongoing home medical care, including nutritional and respiratory support, after esophageal atresia surgery. Congenital heart disease increases the need for this long-term support.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Pulmonology
Background:
- Long-term medical needs following definitive surgery for esophageal atresia (EA) are not fully understood.
- Real-world patterns of home medical care and medication use post-discharge are underexplored.
Purpose of the Study:
- To describe long-term home medical care and medication use in infants after definitive EA surgery.
- To identify factors influencing post-operative care needs, including congenital heart disease (CHD).
Main Methods:
- Retrospective analysis of the Japanese national inpatient Diagnosis Procedure Combination database (July 2010-March 2023).
- Inclusion of infants who underwent definitive EA surgery.
- Assessment of home medical care (tracheostomy, ventilation, oxygen, enteral nutrition) and medications (antacids, prokinetics, anti-asthmatics) at 1, 3, 5, and 7 years post-surgery.
- Subgroup analysis based on the presence of CHD.
Main Results:
- 806 patients were analyzed.
- Home enteral nutrition was common (22.0% at 1 year), decreasing over time.
- Antacid and prokinetic agent use also declined.
- Patients with CHD had higher rates of home oxygen therapy and enteral nutrition.
Conclusions:
- A significant proportion of patients require long-term home nutritional and respiratory support after definitive EA surgery.
- Findings highlight critical long-term healthcare needs for EA patients post-surgery.
Purpose:
Long-term medical needs after definitive surgery for esophageal atresia (EA) are incompletely understood. The real-world patterns of home medical care and medication use after hospital discharge remain underexplored.
Methods:
Using the Japanese national inpatient Diagnosis Procedure Combination database, we identified infants who underwent definitive surgery for EA between July 2010 and March 2023. We described patients' background characteristics, perioperative information, long-term home medical care (home tracheostomy care, home mechanical ventilation, home oxygen therapy, and home enteral nutrition), and medication use (antacids, prokinetic agents, and anti-asthmatics) at 1, 3, 5, and 7 years post-definitive surgery. Subgroup analysis based on congenital heart disease (CHD) was conducted.
Results:
Overall, 806 patients met the eligibility criteria. Home enteral nutrition was the most frequently performed home medical care (22.0% of patients at 1 year post-surgery), whose proportion decreased gradually over time. Antacid and prokinetic agent use also declined over time. Subgroup analysis revealed that patients with CHD required home oxygen therapy and home enteral nutrition more frequently than those without CHD.
Conclusions:
A substantial proportion of patients required home longitudinal nutritional and respiratory support post-definitive surgery for EA. Our findings provide important information for long-term healthcare needs of patients receiving definitive surgery for EA.
Level Of Evidence:
III (retrospective comparative study).
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