Postoperative morbidity and health-related quality of life in children with delayed reconstruction of esophageal atresia: a nationwide Swedish study

Abstract

Background In 10-15% of children with esophageal atresia (EA) delayed reconstruction of esophageal atresia (DREA) is necessary due to long-gap EA and/or prematurity/low birth weight. They represent a patient subgroup with high risk of complications. We aimed to evaluate postoperative morbidity and health-related quality of life (HRQOL) in a Swedish national cohort of children with DREA. Methods Postoperative morbidity, age-specific generic HRQOL (PedsQLTM 4.0) and condition-specific HRQOL (The EA-QOL questionnaires) in children with DREA were compared with children with EA who had primary anastomosis (PA). Factors associated with the DREA group’s HRQOL scores were analyzed using Mann-Whitney U-test and Spearman’s rho. Clinical data was extracted from the medical records. Significance level was p<0.05.Results Thirty-four out of 45 families of children with DREA were included and 30 returned the questionnaires(n=8 children aged 2-7 years; n=22 children aged 8-18 years). Compared to children with PA(42 children aged 2-7 years; 64 children aged 8-18 years), there were no significant differences in most early postoperative complications. At follow-up, symptom prevalence in children aged 2-7 with DREA ranged from 37.5% (heartburn) to 75%(cough). Further digestive and respiratory symptoms were present in ≥50%. In children aged 8-18, it ranged from 14.3%(vomiting) to 40.9%(cough), with other digestive and airway symptoms present in 19.0-27.3%. Except for chest tightness(2-7 years), there were no significant differences in symptom prevalence between children with DREA and PA, nor between their generic or condition-specific HRQOL scores(p>0.05). More children with DREA underwent esophageal dilatations (both age groups), gastrostomy feeding(2-7 years), and antireflux treatment (8-18 years), p<0.05. Days to hospital discharge after EA repair and a number of associated anomalies showed a strong negative correlation with HRQOL scores (2-7 years). Presence of cough, airway infection, swallowing difficulties and heartburn were associated with lower HRQOL scores (8-18 years), p<0.05. Conclusions Although children with DREA need more treatments, they are not a risk group for postoperative morbidity and impaired HRQOL compared with children with PA. However, those with a long initial hospital stay, several associated anomalies and digestive or respiratory symptoms risk worse HRQOL. This is important information for clinical practice, families and patient stakeholders.

Health-related quality of life in children after surgical repair of esophageal atresia: a cross-sectional study in China

“…In addition, no primary anastomosis, esophageal dilatation, as well as gastrostomy insertion secondary to long-gap EA or severe gastroesophageal reflux predicted worse scores related to eating domain in all ages; associated anomalies were related to worse body perceptions (16). Another research stated that days of discharge after EA repair and concomitant abnormalities were significantly negatively correlated with HRQOL scores in the 2-7 age group, while relevant respiratory and digestive tract symptoms such as airway infection, swallowing difficulties, and heartburn were associated with lower HRQOL scores in the 8-17 years group (28). Our results support the relevant opinions of the previous literature.…”

Thoracoscopic Stage Internal Traction Repair Reduces Time to Achieve Esophageal Continuity in Long Gap Esophageal Atresia

“…Similarly, a large multicentre study of management and outcomes of isolated LGOA treatment using DPA revealed a high rate of successful reconstructions, but prolonged LOHS (median 125 days) with a median age at repair of 87 days [23]. A long initial hospital stay, as well as significant associated anomalies, and persistent digestive or respiratory symptoms may negatively influence on health related quality of life (HRQOL) [24]. Other studies have also remarked that a prolonged hospital stay may be related to suboptimal long-term morbidity and neurodevelopment outcomes [25,26].…”