Whether prophylactic intraoperative chest drain insertion in esophageal atresia-tracheoesophageal fistula is an evidence-based practice or just a prejudice | Search in Databases | Systematic review & meta-analysis | 6 articles | 498 Neonates | Group A = with intra-op chest drain (IOCD) | Group B = without IOCD | RESULTS | No significant difference between groups in | Insertions of new post-op chest drains | Anastomotic leaks | Stenosis | GROUP A | Had a higher rate of re-visits to the OR | Conclusion: Prophylactic insertion of chest drain after esophageal repair for esophageal atresia does not reduce complications and may be associated with a higher rate of reoperations | DOI: 10.1016/j.jpedsurg.2021.06.015 | Source: Sachit Anand et al. | Department of Pediatric Surgery, Kokilaben Dhirubhai Ambani Hospital, Mumbai | @StayCurrentMD | @cecilipstick | Cincinnati Children's | Journal of Pediatric Surgery
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
Infographic · Nov 2022 · 1 min read
In brief
In brief
Systematic review of 498 newborns finds no benefit to routine prophylactic chest drain placement during EA-TEF repair, with higher reoperation rates in the drain group. Results challenge common surgical practice but require higher-quality studies for definitive guidance.
- Prophylactic intraoperative chest drains in EA-TEF repair showed no significant reduction in postoperative complications or mortality.
- Routine chest drain insertion was associated with significantly higher return to OR rates (RR 1.75, p=0.03).
- No difference found in anastomotic leak rates, pneumothorax occurrence, or need for postoperative chest drains between groups.
- Current evidence does not support routine prophylactic chest drain placement during EA-TEF repair.
- Practice variation exists among pediatric surgeons; selective rather than routine drain use may be appropriate.
Written by the GCMD Library team from the infographic.
The infographic uses a teal and yellow color scheme with a dark banner at top. It shows a systematic review workflow with calendar and laptop icons, displays study groups with arrow graphics pointing to a cartoon swaddled baby on the right, and presents results in white text boxes with a yellow conclusion panel. Social media handles and journal branding appear at bottom.
Infographic by Cecilia Gigena
"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" Sachit Anand et.al.
Full article: https://www.jpedsurg.org/article/S0022-3468(21)00487-5/pdf
Authors: Sachit Anand, Apoorv Singh, Nellai Krishnan, Devendra Kumar Yadav
Abstract
Background
Various controversial practices in the management of Esophageal atresia-tracheoesophageal fistula (EA-TEF) can be noticed among pediatric surgeons. Routine intraoperative chest drain (IOCD) insertion is often debated and lacks any concrete evidence. This meta-analysis aims to compare the postoperative outcomes among newborns with and without IOCD insertion.
Methods
The authors searched EMBASE, PubMed, Scopus, and Web of Science on 30th April 2021. The requirement for chest drain in the postoperative period (POCD), anastomotic leak (and/or pneumothorax), mortality rate, and revisit(s) to the operation room (RVOR) were compared among two groups of newborns, i.e. groups A and B with and without IOCD insertion respectively. The statistical analysis was performed using a fixed-effects model. The pooled risk ratio (RR) and heterogeneity (I2) were calculated. The methodological quality of the studies was assessed utilizing the Downs and Black scale.
Results
A total of 498 newborns were included in the present analysis. As compared to group B, newborns within group A showed no significant difference in the requirement for POCD (RR 2.47; 95% CI 0.88–6.98, p = 0.09), the occurrence of anastomotic leak and/or pneumothorax (RR 1.35; 95% CI 0.89–2.06, p = 0.16), and mortality rate (RR 2.24; 95% CI 0.81–6.26, p = 0.12). However, RVOR was significantly higher in group A (RR 1.75; 95% CI 1.07–2.87, p = 0.03). All included studies had a moderate risk of bias.
Conclusions
The present meta-analysis revealed no additional benefit of prophylactic IOCD insertion. However, due to moderate risk of bias, further studies need to be conducted for an optimal comparison between the two groups.