Thoracoscopic repair of EA/TEF in neonates is associated with high conversion rates | 4 years | Retrospective cohort study using the ACS National Surgical Quality Improvement Program Pediatric (NSQIP-P) database | 855 PATIENTS were included | 64% full term babies | 62% had severe cardiac disease | 27% needed pre-op ventilator support | Operative approaches | 16% Thoracoscopic | 84% Open Repair | 53% Converted to open | Those who underwent thoracoscopic repair were more likely to be full-term (p=0.03) compared to those with open repair | Operative time | 217 min Thoracoscopic vs 180 min Open Repair | Conclusion: Thoracoscopic repair of EA/TEF in neonates is associated with high conversion rates and has similar perioperative outcomes compared to open repair | https://pubmed.ncbi.nlm.nih.gov/33994203/ | Source: Etchill EW et al. General Pediatric Surgery Johns Hopkins University School of Medicine, Baltimore, MD | @StayCurrentMD | @EmTombash @emencisco @RodGerardo
Association of operative approach with outcomes in neonates with esophageal atresia and tracheoesophageal fistula
Infographic · Jan 2022 · 1 min read
In brief
In brief
This NSQIP database study of 855 neonates found that thoracoscopic EA/TEF repair had a 53% conversion rate to open and similar perioperative outcomes compared to primary open repair, with longer operative times. Major cardiac comorbidities and preoperative ventilation were the only significant risk factors for adverse events.
- Thoracoscopic EA/TEF repair used in only 15.6% of cases with 53% conversion rate to open, suggesting technical challenges in neonates.
- Operative time significantly longer for thoracoscopic approach (217 min vs 180 min), but no difference in 30-day postoperative complications.
- Major cardiac comorbidity and preoperative ventilator dependence are key risk factors for adverse events regardless of surgical approach.
- Thoracoscopic and open repair show equivalent perioperative safety profiles in neonatal EA/TEF repair.
- Full-term infants more likely selected for thoracoscopic approach, indicating surgeon preference for less complex cases.
Written by the GCMD Library team from the infographic.
Multi-panel infographic with teal and yellow color scheme. Top section displays study parameters with calendar icon and baby illustration. Middle section shows operative approach percentages with arrow indicating conversion rate and surgical hand illustration. Bottom section presents operative time comparison and conclusion in yellow box. Social media handles and citation appear at bottom.
Purpose: We sought to evaluate the impact of thoracoscopic repair on perioperative outcomes in infants with esophageal atresia and tracheoesophageal fistula (EA/TEF).
Methods: The American College of Surgeons National Surgical Quality Improvement Program pediatric database from 2014 to 2018 was queried for all neonates who underwent operative repair of EA/TEF. Operative approach based on intention to treat was correlated with perioperative outcomes, including 30-day postoperative adverse events, in logistic regression models.
Results: Among 855 neonates, initial thoracoscopic repair was performed in 133 (15.6%) cases. Seventy (53%) of these cases were converted to open. Those who underwent thoracoscopic repair were more likely to be full-term ( p = 0.03) when compared to those in the open repair group. There were no sig- nificant differences in perioperative outcome measures based on surgical approach except for operative time (thoracoscopic: 217 min vs. open: 180 min, p < 0.001). A major cardiac comorbidity (OR 1.6, 95% CI 1.2–2.1; p = 0.003) and preoperative ventilator requirement (OR 1.4, 95% CI 1.0–1.9; p = 0.034) were the only risk factors associated with adverse events.
Conclusions: Thoracoscopic neonatal repair of EA/TEF continues to be used sparingly, is associated with high conversion rates, and has similar perioperative outcomes when compared to open repair.