Tracking Outcomes of Tracheoesophageal Fistula and Esophageal Atresia in Pediatric Population
*Ishna Sharma, *Shefali Thaker, *Todd Jensen, Christine Finck
Connecticut Children's Medical Center, Hartford, CT
Objective: The objective of this study was to conduct a retrospective chart review of patients with a rare congenital deformity, tracheoesophageal fistula (TEF) and esophageal atresia (EA). The goal was to identify important variables to inform clinical pathways and prospective database creation. Current national surgical quality databases do not track TEF/EA-specific data points such as TEF-type and incidence of postoperative complications such as GERD and esophageal stricture.
Design: Cohort study with minimum 1 year post-procedure follow-up.
Setting: Urban pediatric tertiary hospital.
Patients: All patients diagnosed with EA/TEF between 2005 and 2019 were identified using ICD 9/10 codes, amounting to 43 patients. 64.3% of patients were female and 35.7% male. 4 patients were not included in subgroup analysis: 2 had missing variables, 1 passed away before surgical intervention, and 1 has not yet undergone surgical intervention.
Interventions: Surgical intervention.
Main Outcome Measures: Data for 35 variables were abstracted. SPSS 16.0 software was used for descriptive statistics.
Results: 77.5% of cases were type C, 12.5% type A, 7.5% type H, and 2.5% type D. 15% were long gap type. 100% patients received postoperative fluorogram, with mean postoperative day 7.73. 53.8% had postoperative esophageal strictures, and 66.7% had postoperative gastroesophageal reflux disease. Of those who had strictures, 77.2% of patients required at least 3 postoperative dilations for stricture, with overall mean 6 dilations. 26.2% of patients developed tracheomalacia; of these, 2 underwent thoracoscopic aortopexy. 7.9% patients had TEF recurrence requiring intervention.
Conclusions:
We conclude that although a rare congenital anomaly, a database dedicated to EA/TEF at a pediatric hospital can aid in reviewing trends in outcomes and inform standardization of management.
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