Anastomotic Leak and its Implications: A Multicenter Analysis of “Type C” Esophageal Atresia / Tracheo-esophageal fistula (EA/TEF)
Infographic · Jan 2025 · 1 min read
In brief
In brief
Multicenter study of 365 infants with type C EA/TEF found 15% developed anastomotic leak, associated with thoracoscopic approach, lower birthweight, and staged repair. Leak significantly prolonged hospital stay, with 11-fold variation across centers suggesting opportunities for standardized care improvement.
- Anastomotic leak occurs in 15% of type C EA/TEF repairs and is associated with thoracoscopic approach, lower birthweight, and staged repair
- Esophageal anastomotic leak significantly prolongs hospital length of stay independent of other clinical factors
- 11-fold variation in length of stay across centers suggests opportunity to identify and standardize best practices
- Male sex, SGA <10th percentile, and VSD are independent risk factors for anastomotic leak after EA/TEF repair
Written by the GCMD Library team from the infographic.
Ankur Datta, Karna Murthy, Isabella Zaniletti, Yigit Guner, Michael A. Padula, Theresa R. Grover, Benjamin Zendejas, Shawn D. St. Peter, Jose Diaz-Miron, Mark Speziale, Jacquelyn R. Evans, Loren Berman
Purpose: Repair of type C esophageal atresia with tracheo-esophageal fistula (EA/TEF) may be complicated by esophageal anastomotic leak. Risk factors associated with leak and the impact of leak on inpatient outcomes remains uncertain. Our objectives are to estimate the associations between clinical factors and esophageal anastomotic leak and quantify the association of leak with length of stay (LOS) in infants who underwent repair of type C EA/TEF.
Methods: Using the Children’s Hospitals Neonatal Database (CHND), we identified infants with type C EA/TEF from 2021-2023. The main outcomes were anastomotic leak and LOS. Multivariable associations between patient and clinical factors and these outcomes were quantified using logistic regression (leak) and Cox proportional hazards modelling (LOS).
Results: Among 365 infants at 36 centers, anastomotic leak occurred in 55 (15.1%) infants, and thoracoscopic approach, lower birthweight, small for gestational age less than 10th percentile, male sex, staged repair, ventricular septal defect, and center were independently associated with leak (area under receiver operating curve = 0.853). Also, LOS was increased in infants with leak compared to those without [hazard ratio (HR): 0.655, 95% CI = 0.431 – 0.996, p=0.044], independent of birth weight, surgical approach, male sex, or VSD. The adjusted LOS demonstrated a 11-fold inter-center variation (p=0.034).
Conclusions: Several clinical and operative factors are associated with esophageal anastomotic leak in infants after type C EA/TEF repair. Leak significantly prolongs LOS. The magnitude of inter-center variability in LOS also suggests that identifying best practices could aid in improving patient care in this patient population.