Whether prophylactic intraoperative chest drain insertion in esophageal atresia-tracheoesophageal fistula is an evidence-based practice or just a prejudice: A systematic review and meta-analysis
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In brief
In brief
This systematic review and meta-analysis of 498 newborns challenges the routine practice of prophylactic intraoperative chest drain insertion during EA-TEF repair, finding no significant benefit in reducing postoperative complications, anastomotic leaks, or mortality. The study reveals higher rates of return to OR in the drain group, questioning this common surgical prejudice.
Written by the GCMD Library team from the article.
Background
Various controversial practices in the management of Esophageal atresia-tracheoesophageal fistula (EA-TEF) can be noticed among pediatric surgeons. Routine intraoperative chest drain (IOCD) insertion is often debated and lacks any concrete evidence. This meta-analysis aims to compare the postoperative outcomes among newborns with and without IOCD insertion.
Methods
The authors searched EMBASE, PubMed, Scopus, and Web of Science on 30th April 2021. The requirement for chest drain in the postoperative period (POCD), anastomotic leak (and/or pneumothorax), mortality rate, and revisit(s) to the operation room (RVOR) were compared among two groups of newborns, i.e. groups A and B with and without IOCD insertion respectively. The statistical analysis was performed using a fixed-effects model. The pooled risk ratio (RR) and heterogeneity (I2) were calculated. The methodological quality of the studies was assessed utilizing the Downs and Black scale.
Results
A total of 498 newborns were included in the present analysis. As compared to group B, newborns within group A showed no significant difference in the requirement for POCD (RR 2.47; 95% CI 0.88-6.98, p=0.09), the occurrence of anastomotic leak and/or pneumothorax (RR 1.35; 95% CI 0.89-2.06, p=0.16), and mortality rate (RR 2.24; 95% CI 0.81-6.26, p=0.12). However, RVOR was significantly higher in group A (RR 1.75; 95% CI 1.07-2.87, p=0.03). All included studies had a moderate risk of bias.
Conclusions
The present meta-analysis revealed no additional benefit of prophylactic IOCD insertion. However, due to moderate risk of bias, further studies need to be conducted for an optimal comparison between the two groups.