Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, U.S.A.
Department of Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, U.S.A.
Laryngoscope. 2022 Mar;132(3):695-700. doi: 10.1002/lary.29798. Epub 2021 Aug 9.
We examined rates of upper aerodigestive tract (UADT) procedures in a multi-institutional cohort of neonates with esophageal atresia/tracheoesophageal fistula (EA/TEF) to estimate secondary UADT pathology.
A retrospective cohort study was performed using a previously-validated population of patients with EA/TEF within the Pediatric Health Information System (PHIS) between 2007 and 2015. ICD-9/10-CM codes for aerodigestive procedures were examined from 2007 to 2020: 1) diagnostic direct laryngoscopy and/or bronchoscopy (DLB), 2) DLB with intervention, 3) tracheostomy, 4) gastrostomy, 5) fundoplication, 6) aortopexy, 7) laryngotracheoplasty, and 8) esophageal dilation. Associations between procedures and demographics, length of gestation, and weight were estimated using generalized linear mixed models.
We identified 2,509 patients with EA/TEF from 47 hospitals, 56.7% male and 43.3% female. Median length of stay for the first admission was 24 days (interquartile range: 12-55). Of these patients, 1,943 (77.4%) had at least one aerodigestive procedure within 14 admissions. Specifically, 1,635 (65.2%) underwent diagnostic DLB, 85 (3.4%) DLB with intervention, 167 (6.7%) tracheostomy, 1,043 (41.2%) gastrostomy, 211 (11.0%) fundoplication, 52 (2.1%) aortopexy, 161 (6.4%) laryngotracheoplasty, and 207 (8.3%) esophageal dilation. Preterm gestation increased odds of tracheostomy (adjusted odds ratio (OR) 2.4, 95% confidence interval (CI) 1.5-3.7), gastrostomy (OR 2.1, CI 1.7-2.7), fundoplication (OR 1.7, CI 1.1-2.4), aortopexy (OR 5.8, CI 2.1-16.1), and esophageal dilation (OR 2.0, CI 1.4-3.0). Very low birth weight (<1,500 g) increased odds of gastrostomy (OR 2.5, CI 1.6-3.8).
Patients with EA/TEF frequently have aerodigestive sequelae. This work helps quantify aerodigestive needs in neonates with EA/TEF, suggesting early otolaryngology evaluation in their care.
3 Laryngoscope, 132:695-700, 2022.
我们检查了多机构食管闭锁/气管食管瘘（EA/TEF）新生儿队列中上呼吸道（UADT）手术的发生率，以估计继发性 UADT 病理。
使用儿科健康信息系统（PHIS）中之前验证过的 EA/TEF 患者人群进行回顾性队列研究，时间范围为 2007 年至 2015 年。检查了 2007 年至 2020 年期间的空气消化程序的 ICD-9/10-CM 代码：1）诊断性直接喉镜和/或支气管镜检查（DLB），2）DLB 介入，3）气管切开术，4）胃造口术，5）胃底折叠术，6）主动脉固定术，7）喉气管成形术和 8）食管扩张术。使用广义线性混合模型估计程序与人口统计学、妊娠时间和体重之间的关联。
我们从 47 家医院确定了 2509 名 EA/TEF 患者，其中 56.7%为男性，43.3%为女性。首次入院的中位住院时间为 24 天（四分位间距：12-55）。这些患者中，1943 名（77.4%）在 14 次住院期间至少进行了一次空气消化程序。具体来说，1635 名（65.2%）接受了诊断性 DLB，85 名（3.4%）接受了 DLB 介入，167 名（6.7%）接受了气管切开术，1043 名（41.2%）接受了胃造口术，211 名（11.0%）接受了胃底折叠术，52 名（2.1%）接受了主动脉固定术，161 名（6.4%）接受了喉气管成形术，207 名（8.3%）接受了食管扩张术。早产会增加气管切开术（调整后的优势比（OR）2.4，95%置信区间（CI）1.5-3.7）、胃造口术（OR 2.1，CI 1.7-2.7）、胃底折叠术（OR 1.7，CI 1.1-2.4）、主动脉固定术（OR 5.8，CI 2.1-16.1）和食管扩张术（OR 2.0，CI 1.4-3.0）的几率。极低出生体重（<1500 克）增加了胃造口术（OR 2.5，CI 1.6-3.8）的几率。
EA/TEF 患者经常出现呼吸道后遗症。这项工作有助于量化 EA/TEF 新生儿的呼吸道需求，表明在他们的治疗中应尽早进行耳鼻喉科评估。
3 喉镜，132：695-700，2022 年。
