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
Topic overview
Systematic review comparing outcomes in EA-TEF repair with versus without prophylactic intraoperative chest drains found no significant benefit in postoperative drain requirement, leak rates, or mortality. Prophylactic drain placement was associated with higher return-to-OR rates, questioning routine use.
Key takeaways
- Prophylactic intraoperative chest drain in EA-TEF repair shows no significant reduction in postoperative drain need, leak rates, or mortality.
- Routine IOCD insertion associated with significantly higher return to OR rates (RR 1.75, p=0.03) compared to selective drain placement.
- Meta-analysis of 498 newborns found no evidence supporting routine chest drain insertion as standard practice in EA-TEF repair.
- Current practice of prophylactic IOCD may be tradition-based rather than evidence-based; selective approach appears equally safe.
- Moderate study bias limits conclusions; high-quality RCTs needed to definitively guide chest drain use in EA-TEF surgery.
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