The effect of postoperative ventilation strategies on postoperative complications and outcomes in patients with esophageal atresia: Results from the Turkish Esophageal Atresia Registry

• Published in: Pediatric pulmonology Vol. 58; no. 3; pp. 763 - 771
• Main Authors: Cömert, Hatice Sonay Yalçın, Güney, Doğuş, Durakbaşa, Çiğdem Ulukaya, Dökümcü, Zafer, Soyer, Tutku, Fırıncı, Binali, Çiftçi, İlhan, Öztan, Mustafa Onur, Demirel, Berat Dilek, Parlak, Ayşe, Göllü, Gülnur, Karaman, Ayşe, Akkoyun, İbrahim, Gül, Cengiz, İlhan, Hüseyin, Oral, Akgün, Özcan, Rahşan, Özen, Önder, Kıyan, Gürsu, Erdem, Ali Onur, Özaydın, Seyithan, Uzunlu, Osman, Yıldız, Abdullah, Erginel, Başak, Ertürk, Nazile, Bilici, Salim, Samsum, Hakan, Özen, Mehmet Ali, Özçakır, Esra, Aydın, Emrah, Mert, Mehmet, Topbaş, Murat
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-03-2023
• Subjects: Child; complication; esophageal atresia; Esophageal Atresia - complications; Esophagus; Fistula; Humans; mechanical ventilation; Postoperative Complications - epidemiology; Retrospective Studies; tracheoesophageal fistula; Tracheoesophageal Fistula - complications; Treatment Outcome; Ventilation; complication; mechanical ventilation; esophageal atresia; tracheoesophageal fistula
• ISSN: 8755-6863; 1099-0496
• DOI: 10.1002/ppul.26251

Objectives
Postoperative ventilatory strategies in patients with esophageal atresia (EA) and tracheoesophageal fistula (TEF) may have an impact on early postoperative complications. Our national Esophageal Atresia Registry was evaluated to define a possible relationship between the type and duration of respiratory support on postoperative complications and outcome.
Study Design
Among the data registered by 31 centers between 2015 and 2021, patients with esophago‐esophageal anastomosis (EEA)/tracheoesophageal fistula (TEF) were divided into two groups; invasive ventilatory support (IV) and noninvasive ventilatory support and/or oxygen support (NIV‐OS). The demographic findings, gestational age, type of atresia, associated anomalies, and genetic malformations were evaluated. We compared the type of repair, gap length, chest tube insertion, follow‐up times, tensioned anastomosis, postoperative complications, esophageal dilatations, respiratory problems requiring treatment after the operation, and mortality rates.
Results
Among 650 registered patients, 502 patients with EEA/TEF repair included the study. Four hundred and seventy of patients require IV and 32 of them had NIV‐OS treatment. The IV group had lower mean birth weights and higher incidence of respiratory problems when compared to NIV‐OS group. Also, NIV‐OS group had significantly higher incidence of associated anomalies than IV groups. The rates of postoperative complications and mortality were not different between the IV and NIV‐OS groups.
Conclusion
We demonstrated that patients who required invasive ventilation had a higher incidence of low birth weight and respiratory morbidity. We found no relation between mode of postoperative ventilation and surgical complications. Randomized controlled trials and clinical guidelines are needed to define the best type of ventilation strategy in children with EA/TEF.