The value of prophylactic chest tubes in tracheoesophageal fistula repair.

Infographic · Sep 2020 · 1 min read

In brief

This case-control study of 109 EA/TEF patients found that prophylactic intraoperative chest tubes did not reduce pneumothorax or leak rates, nor prevent need for postoperative tubes. Instead, IOCTs were associated with longer hospital stays and higher stricture rates requiring reoperation, suggesting they may not benefit EA/TEF repair outcomes.

Intraoperative chest tubes during EA/TEF repair did not reduce pneumothorax or leak rates compared to selective postoperative placement.
Prophylactic chest tubes were associated with significantly longer hospital stays (28 vs 15.5 days, p<0.001).
IOCT placement correlated with higher esophageal stricture rates requiring reoperation (30% vs 8%, p=0.04).
Early detection of complications was not improved by routine intraoperative chest tube placement.
Selective rather than routine chest tube placement may optimize outcomes in type C EA/TEF repair.

Written by the GCMD Library team from the infographic.

The infographic uses a left-to-right flow with five panels on a white background with red header. It begins with an anatomical illustration of a child's profile showing esophageal atresia, followed by icons representing clinical outcomes: lungs with pneumothorax indication, a cylindrical tube representing anastomotic leak, an hourglass shape for stricture, and a hospital building. Red arrows and symbols highlight increased risks associated with pleural tube placement.

Purpose

Intraoperative chest tubes (IOCTs) can be placed during esophageal atresia/tracheoesophageal fistula (EA/TEF) repair to control pneumothoraces and detect esophageal leaks, potentially preventing the need for postoperative chest tubes (POCTs). However, data are lacking regarding IOCTs’ effect. We hypothesized that IOCT placement would not reduce the risk of POCT placement and would increase hospital length of stay (LOS).

Methods

This was a single-center case-control study of type C EA/TEF patients repaired at a tertiary referral center between 2006 and 2017. Postoperative complications of patients who received IOCTs (n = 83) were compared to that of patients who did not receive IOCTs (n = 26). Patients were compared via propensity score matching. Additionally, sensitivity analyses excluding low birth weight (LBW) patients and patients undergoing delayed esophageal anastomosis were also performed.

Results

There was no significant difference in rates of pneumothoraces or esophageal leaks between the IOCT and no-IOCT groups, nor were either of these complications detected earlier in the IOCT group. Rates of POCT placement and mortality also did not differ between groups. IOCT patients were associated with increased hospital LOS (28 vs 15.5 days, p < 0.001) and esophageal strictures (30% vs 8%, p = 0.04) requiring a return to the operating room (RTOR).

Conclusion

IOCTs did not improve outcomes in EA/TEF repair. IOCTs seem associated with increased LOS and ROTR for esophageal stricture, suggesting that IOCTs may not be beneficial after EA/TEF repair.

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