A retrospective comparative study to determine the factors leading to poor outcome in operated cases of esophageal atresia and trachea-esophageal fistula: An audit

Abstract

Aim: To determine the different factors leading to poor outcome in operated case of esophageal atresia and trachea-esophageal fistula (EA-TEF). Material and Methods: This is a retrospective non-randomized comparative study. All the patient who presented with EA-TEF to us were included in the study. The patients who were not operated and patient who were discharged against the advice were excluded from the study. Patients were divided in to two groups. Group-A- Those who have survived after the surgery-39 and Group-B those who expired after the surgery-38. Various parameters were considered in relation to pre-operative, intra-operative and post-operative factors. To name few antenatal findings, maternal hemoglobin, gestational age, gap between both the end, duration of procedure, need for mechanical ventilation, early start of NG feed, need for blood products and postoperative complications. Results: Preoperative factor which had significant negative impact on survival were antenatally diagnosed polyhydramnios, maternal anemia, gestational age and associated severe cardiac anomalies. Mean operating time was more in group-B. Whenever surgeons or anaesthesiologists decided to continue postoperative ventilation the outcome was poor- 34 needed post-operative ventilation in group-B versus 12 in group A. Need for blood transfusion and need for platelets transfusion did not show significant difference among two groups but the need for plasma transfusion had poor survival. SIRS/sepsis played important determining factor in survival of EA-TEF. Patients who could be fed early, had better survival. Pneumothorax, pneumonia and leak didn’t show significant difference in survival. Conclusion: Different factors before, during and after the surgery have impact on outcome of EA-TEF. We should be able to formulate prognostic score which is based our local needs and available resources.