Journal of pediatric surgery · 2026
Perioperative risk factors for short- and long-term respiratory morbidity in patients with esophageal atresia.
СтатьяНазвание и аннотация: Перевод в очереди
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Johnson Drew, Sims Jessica K, Lucas Elizabeth R, French Mary Peyton, Wootten Christopher, Robinson Jamie
Аннотация
PURPOSE: Respiratory complications are a major source of morbidity in esophageal atresia (EA), yet predictors of short- and long-term respiratory outcomes are not well defined. This study aimed to identify perioperative factors associated with respiratory morbidity in EA/TEF patients.
METHODS: We conducted a retrospective cohort study of 242 EA patients treated at a single tertiary center from 2005 to present. Short-term respiratory morbidity was defined as the need for supplemental respiratory support at 30 days postoperatively from primary EA repair. Long-term morbidity was determined based on a composite outcome that consisted of: tracheostomy, secondary tracheopexy, recurrent pneumonia, chronic pulmonary disease, or ongoing respiratory support at last follow-up. Preoperative factors including gestational age, birthweight, syndromic diagnoses, congenital heart disease and long-gap atresia, were evaluated using univariate and multivariable logistic regression.
RESULTS: Of the 242 patients, 167 had complete short- and long-term follow-up; 48 (28.7%) required respiratory support at 30 days following EA repair. Prematurity, birthweight <2 kg, and syndromic EA (VACTERL, CHARGE/Other, trisomy) were independently associated with short-term respiratory morbidity (p < 0.01). Among these 167 patients, 77 (46.1%) developed chronic respiratory morbidity. Early postoperative respiratory status, specifically the need for supplemental respiratory support at 30 days, was the only independent predictor of long-term morbidity (OR 4.69, 95% CI 1.54-15.48).
CONCLUSION: Preoperative characteristics predict short-term respiratory morbidity but do not reliably predict long-term outcomes. Notably, early postoperative respiratory status is the key determinant of chronic respiratory morbidity. Recognition of at-risk patients may guide postoperative management and follow-up strategies.
LEVEL OF EVIDENCE: IIb.
METHODS: We conducted a retrospective cohort study of 242 EA patients treated at a single tertiary center from 2005 to present. Short-term respiratory morbidity was defined as the need for supplemental respiratory support at 30 days postoperatively from primary EA repair. Long-term morbidity was determined based on a composite outcome that consisted of: tracheostomy, secondary tracheopexy, recurrent pneumonia, chronic pulmonary disease, or ongoing respiratory support at last follow-up. Preoperative factors including gestational age, birthweight, syndromic diagnoses, congenital heart disease and long-gap atresia, were evaluated using univariate and multivariable logistic regression.
RESULTS: Of the 242 patients, 167 had complete short- and long-term follow-up; 48 (28.7%) required respiratory support at 30 days following EA repair. Prematurity, birthweight <2 kg, and syndromic EA (VACTERL, CHARGE/Other, trisomy) were independently associated with short-term respiratory morbidity (p < 0.01). Among these 167 patients, 77 (46.1%) developed chronic respiratory morbidity. Early postoperative respiratory status, specifically the need for supplemental respiratory support at 30 days, was the only independent predictor of long-term morbidity (OR 4.69, 95% CI 1.54-15.48).
CONCLUSION: Preoperative characteristics predict short-term respiratory morbidity but do not reliably predict long-term outcomes. Notably, early postoperative respiratory status is the key determinant of chronic respiratory morbidity. Recognition of at-risk patients may guide postoperative management and follow-up strategies.
LEVEL OF EVIDENCE: IIb.