Operative Approach & Post-op Outcomes in Neonatal EA/TEF Repair | Retrospective Study | NSQIP* pediatric database | 2013 - 2020 | *National Surgical Quality Improvement Program | 1738 neonates underwent EA/TEF repair | Open vs. Minimally invasive surgery (MIS) | MIS utilization ↑↑ over time | MIS | Open | Median operative time (minutes) (p < 0.001) | 209 | 174 | Post-op intervention (p < 0.001) | 7.6% | 2.9% | Composite morbidity* (p = 0.86) | 24.4% | 25.0% | *No differences in composite morbidity outside of reintervention. | Conclusion: MIS approach for neonatal EA/TEF shows higher reintervention rates. Further studies are needed to clarify short and long term outcomes. | https://pubmed.ncbi.nlm.nih.gov/39147683/ | Source: Castro P et. al. | Philadelphia College of Osteopathic Medicine, Philadelphia, PA, United States | @EmGooteeМD | @StayCurrentMD | Cincinnati Children's | Journal of Pediatric Surgery
Association of Operative Approach With Postoperative Outcomes in Neonates Undergoing Surgical Repair of Esophageal Atresia and Tracheoesophageal Fistula
Infographic · Dec 2024 · 1 min read
In brief
In brief
This propensity-matched NSQIP study of 1,738 neonates found that minimally invasive EA/TEF repair was associated with longer operative times and higher reintervention rates compared to open repair, despite similar composite morbidity. The findings suggest careful patient selection is warranted as MIS adoption increases for this congenital anomaly.
- MIS repair of EA/TEF has longer operative time (209 vs 174 min) compared to open approach in matched neonatal cohorts.
- MIS approach shows 2.6x higher reintervention rate (7.6% vs 2.9%) without difference in overall composite morbidity (24-25%).
- MIS utilization for EA/TEF repair increased 2013-2020 despite higher reintervention rates; long-term outcome data still needed.
- Propensity-matched analysis controlled for prematurity, weight, ventilator dependence, and cardiac risk factors between groups.
- No difference in composite morbidity between MIS and open EA/TEF repair suggests comparable safety profiles in selected patients.
Written by the GCMD Library team from the infographic.
The infographic uses a teal and gray color scheme with three main sections. The top section introduces the study with an illustration of a researcher and a mother holding an infant. The middle section presents comparative data in two columns (MIS in red, Open in blue) with surgical instrument illustrations. The bottom section contains the conclusion in a yellow banner, followed by source attribution and institutional logos.
Paulo Castro, Fari Fall, Devon Pace, Shale J Mack, David H Rothstein, Courtney L Devin, Emily Sagalow, Allison F Linden, Matthew Boelig, Lindsey Asti, Loren Berman
Introduction: Minimally invasive surgery (MIS) is gaining traction as a first-line approach to repair congenital anomalies. This study aims to evaluate outcomes for neonates undergoing open versus MIS repairs for esophageal atresia/tracheoesophageal fistula (EA/TEF).
Methods: In this retrospective study, neonates undergoing EA/TEF repair from 2013 to 2020 were identified using the National Surgical Quality Improvement Program-Pediatric database. Proportions of operative approach (open vs. MIS) over time were analyzed. A propensity score-matched analysis using preoperative characteristics was performed and outcomes were compared including composite morbidity and reintervention rates (overall, major [thoracoscopy, thoracotomy], and minor [chest/feeding tube placement, endoscopy]) between operative approaches. Pearson's chi-square or Fisher's exact tests were used as appropriate.
Results: We identified 1738 neonates who underwent EA/TEF repair. MIS utilization increased over time. Pre-match, neonates undergoing open repair were more likely to be premature, lower weight, ventilator dependent, and have cardiac risk factors with higher severity. Post-match, the groups were similar and included 340 neonates per group. MIS repair was associated with longer median operative time (209 vs. 174 min, p < 0.001) and increased overall post-operative intervention rates (7.6% vs. 2.9%, p = 0.01). There were no differences in composite morbidity (24.4% vs. 25.0%, p = 0.86) outside of reintervention.
Conclusion: MIS approach for neonates with EA/TEF appears to be associated with a higher rate of reinterventions. Further studies evaluating MIS approaches for the repair of EA/TEF are needed to better define short- and long-term outcomes.