Early complications after esophageal atresia repair: analysis of a German health insurance database covering a population of 8 million

Abstract

The treatment of esophageal atresia is not centralized in Germany. Therefore, high numbers of departments are involved. Data on the results of esophageal atresia repair from Germany are lacking. The aim of this study was to evaluate the early postoperative results after repair of esophageal atresia based on unbiased data of a German health insurance. We aimed to determine whether characteristics of the departments had an impact on outcome and compared the results from this study with the literature data from centers with a high caseload. Data of a German health insurance covering ∼10% of the population were analyzed. All patients who had undergone esophageal atresia repair from January 2007 to August 2012 were included. Follow-up data of 1 year postoperatively were analyzed. The potential impact of various characteristics of the treating surgical institutions was assessed. Results were compared with the latest international literature. Seventy-five patients with esophageal atresia underwent reconstructive surgery in 37 departments. The incidences of anastomotic leak (3%) and recurrent tracheoesophageal fistula (7%) were comparable with the literature (both 2-8%). Anastomotic stricture required dilatation in 57% of patients (mean 5.1 ± 5.6 dilatations) comparing unfavorably to most, but not all international reports. During 1-year follow-up, 93% of the patients were readmitted at least once (mean 3.9 ± 3.1 admissions). The incidence of complications did not correlate with any of the characteristics of the treating institutions such as academic affiliation, the number of consultants, beds, and preterm infants treated per year (all P > 0.05). Based on unbiased data, postoperative results after repair of esophageal atresia in Germany are comparable with recently published reports from international single centers. A correlation between the complication rate and characteristics of the treating institutions was not identified.

Postoperative Complications and Functional Outcome after Esophageal Atresia Repair: Results from Longitudinal Single-Center Follow-Up

“…8 Because of its rarity and complex nature, EA/TEF represents one of the major therapeutic challenges not only in modern pediatric surgery but also for other specialties involved due to serious short-and long-term morbidities. [13][14][15][16][17][18] Our results were consistent with previous studies indicating that despite precise esophageal reconstruction and excellent postoperative care, early and late complications frequently occur and must be dealt with. [19][20][21][22] The definition of possible complications is however lacking standardization, which makes an exact comparison with the literature difficult and thus results in highly variable incidence rates.…”

“…[19][20][21][22] The definition of possible complications is however lacking standardization, which makes an exact comparison with the literature difficult and thus results in highly variable incidence rates. 13,14 It can be assumed that the development of complications after initial EA/TEF repair is most likely a multifactorial process that depends on applied surgical techniques, peri-/postoperative care, and individual patient factors. 29 Early complications in our cohort included minor (6.3%) or major (5.2%) anastomotic leaks, recurrent TEF with (1.0%) or without (9.4%) anastomotic stricture, initially missed proximal fistula (4.2%) and refractory anastomotic strictures with (1.0%) or without (2.1%) fistula.…”

“…9,10 Today, improved survival of newborns with EA/TEF is likely related to multiple factors including advances in neonatal intensive care and anesthesia, refined surgical techniques, parenteral nutrition, and antibiotics. 11,12 However, early [13][14][15] and late [16][17][18] postoperative morbidities frequently occur after initial repair of EA/TEF despite excellent surgical and neonatal management, and can be associated with impaired outcomes. Early recognition and treatment of potential complications is therefore essential in order to prevent poor long-term results.…”

Does continuous positive airway pressure for extubation in congenital tracheoesophageal fistula increase the risk of anastomotic leak? A retrospective cohort study

“…Oesophageal AL is an important post‐operative complication, with an incidence of 2–8% . While majority of the leaks are asymptomatic and heal spontaneously, they can also lead to mediastinitis, recurrence of the fistula and oesophageal strictures…”

“…7 Oesophageal AL is an important post-operative complication, with an incidence of 2-8%. [8][9][10][11][12][13][14] While majority of the leaks are asymptomatic and heal spontaneously, they can also lead to mediastinitis, recurrence of the fistula 15 and oesophageal strictures. 16 What is already known on this topic 1 Anastomotic leak is a known complication after repair of tracheoesophageal fistula (TOF).…”