Dewitt-Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine.
University of Miami Miller School of Medicine.
J Pediatr Surg. 2020 May;55(5):824-829. doi: 10.1016/j.jpedsurg.2020.01.025. Epub 2020 Feb 12.
The purpose of this study is to identify determinants of mortality and hospital readmission in infants born with esophageal atresia ± tracheoesophageal fistula.
The Nationwide Readmissions Database (2010-2014) was queried for newborns with a diagnosis of esophageal atresia. Outcomes included mortality and readmissions at 30-day and 1-year.
3157 patients were identified, of which 54% were male. 81% had an additional congenital anomaly, and 35% had VACTERL association. Overall mortality at index hospitalization was 11% (n = 360) and was significantly higher with additional congenital anomalies (13%), VACTERL (19%), and Spitz classification II/III (18%) vs. isolated esophageal atresia/tracheoesophageal fistula (4%), all p < 0.001. After esophageal atresia repair (n = 2179), 10% (n = 212) were readmitted within 30 days and 26% (n = 563) within 1 year, with 17% admitted to different hospitals. Common diagnoses during readmission were GERD (54%), infections (42%), failure to thrive (17%), tracheomalacia (14%), and esophageal stricture (10%). Unplanned readmissions accounted for 85% of readmissions. A large number underwent operative procedures, most commonly esophageal dilation (17%) and fundoplication/gastrostomy (12%).
Our study has uncovered a high likelihood of complications and unplanned readmission within the first year of life for newborns with esophageal atresia. Coordinated multidisciplinary care may help to decrease unnecessary readmissions and improve outcomes in this vulnerable population.
Retrospective comparative analysis.
Level III.
本研究旨在确定伴有或不伴有气管食管瘘的食管闭锁婴儿的死亡率和住院再入院的决定因素。
从全国再入院数据库（2010-2014 年）中查询诊断为食管闭锁的新生儿。结果包括 30 天和 1 年的死亡率和再入院率。
共确定 3157 例患者，其中 54%为男性。81%有其他先天性异常，35%有 VACTERL 关联。指数住院期间的总体死亡率为 11%（n=360），伴有其他先天性异常（13%）、VACTERL（19%）和 Spitz 分类 II/III（18%）的死亡率显著更高，与单纯性食管闭锁/气管食管瘘（4%）相比，均<0.001。食管闭锁修复后（n=2179），30 天内再入院 10%（n=212），1 年内再入院 26%（n=563），17%转至其他医院。再入院的常见诊断为 GERD（54%）、感染（42%）、生长不良（17%）、气管软化（14%）和食管狭窄（10%）。计划外再入院占再入院的 85%。大量患者接受了手术治疗，最常见的是食管扩张（17%）和胃底折叠术/胃造口术（12%）。
我们的研究发现，患有食管闭锁的新生儿在生命的第一年有很高的发生并发症和计划外再入院的可能性。协调的多学科护理可能有助于减少不必要的再入院，并改善这一脆弱人群的结局。
回顾性比较分析。
III 级。
