Outcomes after open thoracotomy repair of esophageal atresia with or without tracheoesophageal fistula: A 10-year Middle Eastern multicenter retrospective cohort.

BACKGROUND

Global outcomes after esophageal atresia (EA) repair vary widely, yet contemporary data from resource-constrained Middle Eastern settings are scarce. Characterizing risks and care gaps can guide quality improvement. This retrospective study addresses this gap and quantifies mortality, complication severity, feeding status, and determinants of hospital length of stay (LOS) after open thoracotomy EA repair.

DESIGN

Multicenter retrospective cohort of infants undergoing EA repair across five West Bank and East Jerusalem hospitals, 1 Jan 2015 to 31 Mar 2025; n = 139 repaired cases.

MAIN FINDINGS: Short-term complications occurred in 29.2 % (38/130); long-term complications in 67.0 % (73/109). Among 98 with any complication: 8.2 % were mild, 50.0 % moderate, and 41.8 % severe. Median LOS was 23.5 days (IQR 15-41). Prematurity prolonged LOS (51.6 ± 45.6 vs 24.2 ± 18.1 days; p = 0.001). Mortality was 20.5 % (27/131 with outcome). Short-term complications increased mortality (34.3 % vs 11.1 %; RR 3.09, 95 % CI 1.47-6.48). In regression, higher gestational age (GA) reduced mortality (OR 0.58/week, 95 % CI 0.38-0.87; p = 0.008); delayed repair increased mortality (OR 1.35/day, 95 % CI 1.08-1.71; p = 0.010).

CONCLUSION

Complications, especially anastomotic strictures and respiratory morbidity, are frequent. Mortality and morbidity concentrate among clinically vulnerable infants. Earlier repair may mitigate risk.