Anastomotic Leak and its Implications: A Multicenter Analysis of “Type C” Esophageal Atresia / Tracheo-esophageal fistula (EA/TEF)

Ankur Datta; Karna Murthy; Isabella Zaniletti; Yigit Guner; Michael A. Padula; Theresa R. Grover; Benjamin Zendejas; Shawn D. St Peter; Jose Diaz-Miron; Mark Speziale; Jacquelyn R. Evans; Loren Berman

doi:10.1016/j.jpedsurg.2024.162015

Anastomotic Leak and its Implications: A Multicenter Analysis of “Type C” Esophageal Atresia / Tracheo-esophageal fistula (EA/TEF)

Ankur Datta^*, Karna Murthy, Isabella Zaniletti, Yigit Guner, Michael A. Padula, Theresa R. Grover, Benjamin Zendejas, Shawn D. St Peter, Jose Diaz-Miron, Mark Speziale, Jacquelyn R. Evans, Loren Berman

^*Corresponding author for this work

Pediatrics

Research output: Contribution to journal › Article › peer-review

Abstract

Purpose: Repair of type C esophageal atresia with tracheo-esophageal fistula (EA/TEF) may be complicated by esophageal anastomotic leak. Risk factors associated with leak and the impact of leak on inpatient outcomes remains uncertain. Our objectives are to estimate the associations between clinical factors and esophageal anastomotic leak and quantify the association of leak with length of stay (LOS) in infants who underwent repair of type C EA/TEF. Methods: Using the Children's Hospitals Neonatal Database (CHND), we identified infants with type C EA/TEF from 2021 to 2023. The main outcomes were anastomotic leak and LOS. Multivariable associations between patient and clinical factors and these outcomes were quantified using logistic regression (leak) and Cox proportional hazards modelling (LOS). Results: Among 365 infants at 36 centers, anastomotic leak occurred in 55 (15.1 %) infants, and thoracoscopic approach, lower birthweight, small for gestational age less than 10th percentile, male sex, staged repair, ventricular septal defect, and center were independently associated with leak (area under receiver operating curve = 0.853). Also, LOS was increased in infants with leak compared to those without [hazard ratio (HR): 0.655, 95 % CI = 0.431–0.996, p = 0.044], independent of birth weight, surgical approach, male sex, or VSD. The adjusted LOS demonstrated a 11-fold inter-center variation (p = 0.034). Conclusions: Several clinical and operative factors are associated with esophageal anastomotic leak in infants after type C EA/TEF repair. Leak significantly prolongs LOS. The magnitude of inter-center variability in LOS also suggests that identifying best practices could aid in improving patient care in this patient population. Type of study: Retrospective Comparative Study. Level of Evidence: III.

Original language	English (US)
Article number	162015
Journal	Journal of pediatric surgery
Volume	60
Issue number	2
DOIs	https://doi.org/10.1016/j.jpedsurg.2024.162015
State	Published - Feb 2025

Funding

Beverly Brozanski, Jacquelyn Evans, Theresa Grover, Karna Murthy, Michael Padula, Eugenia Pallotto, Anthony Piazza, Kristina Reber and Billie Short and ex-officio David Durand, Francine Dykes, Jeanette Asselin, are executive members of the Children's Hospitals Neonatal Consortium, Inc. who developed and manage the CHND (thechnc.org). For more information, please contact: [email protected]. We appreciate Mr. John Mallett and Ms. Evelyn Werbaneth's contribution to study design and data analysis. We are indebted to the following CHNC participating institutions that serve the infants and their families; these institutions (and their site sponsors) also have invested in and continue to participate in the Children's Hospital's Neonatal Database (CHND):, 1. Atlanta, Children's Healthcare of Atlanta \u2013 Egleston (Anthony Piazza). 2. Atlanta, Children's Healthcare of Atlanta - Scottish Rite (Gregory Sysyn). 3. Austin, Dell Children's (Ashley Lucke, Molly Pont). 4. Birmingham, Children's of Alabama (Allison Black, Carl Coghill). 5. Boston Children's Hospital (Anne Hansen). 6. Charlotte, Levine Children's Hospital (Eugenia Pallotto). 7. Chicago, Ann & Robert H. Lurie Children's Hospital (Karna Murthy, Gustave Falciglia). 8. Cincinnati Children's Hospital (Beth Haberman). 9. Cleveland Clinic (Tetyana Nesterenko). 10. Columbus, Nationwide Children's Hospital (Thomas Bartman). 11. Dallas, Children's Medical Center (Sushmita Yallapragada, Lina Chalak). 12. Denver, Children's Hospital Colorado (Danielle Smith, Stephanie Bourque). 13. Detroit, Children's Hospital Michigan (Girija Natarjan). 14. Ft. Worth, Cook Children's Healthcare System (Annie Chi, Yvette Johnson). 15. Hartford, Connecticut Children's (Annmarie Gotiolo). 16. Houston, Texas Children's Hospital (Lakshmi Katarkan, Kristina Reber). 17. Indianapolis, Riley Children's Health (Rebecca Rose). 18. Iowa City, University of Iowa Stead Family Children's Hospital (Julie Lindower). 19. Kansas City, The Children's Mercy Hospital (Julie Weiner). 20. Little Rock, Arkansas Children's (Laura Carroll). 21. Los Angeles Children's Hospital (Rachel Chapman). 22. Madison, American Family Children's Hospital (Nina Menda). 23. Memphis, Le Bonheur Children's Hospital (Mark Weems). 24. Minneapolis, Children's Minnesota (Ann Downey). 25. Milwaukee, Wisconsin Children's Hospital (Joanne Lagatta). 26. Oakland, UCSF Benioff Children's Hospital (Priscilla Joe). 27. Oklahoma Children's Hospital (Trent Tipple, Patricia Williams). 28. Omaha Children's Hospital (Nicole Birge). 29. Orange County, Children's Hospital of Orange County (Michel Mikhael). 30. Orlando, AdventHealth for Children (Narendra Dereddy, Rajan Wadhawan). 31. Orlando, Nemours Children's Hospital (Aaron Weiss). 32. Philadelphia, Children's Hospital of Philadelphia (Michael Padula). 33. Philadelphia, St. Christopher's Hospital for Children (Vilarmis Quinones). 34. Phoenix Children's Hospital (Pam Griffiths). 35. Pittsburgh Children's Hospital (Toby Yanowitz). 36. Rochester, MN, Mayo Clinic Children's (Ellen Bendel-Stenzel). 37. Salt Lake City, Primary Children's Hospital (Con Yee Ling). 38. San Diego, Rady Children's Hospital (Mark Speziale). 39. Seattle Children's Hospital (Robert DiGeronimo, Elizabeth Jacobsen). 40. St. Louis Children's Hospital (Beverly Brozanski, Rakesh Rao). 41. St Paul, Children's Minnesota (Ann Downey). 42. St. Petersburg, All Children's Hospital (Linda Van Marter). 43. Toronto, The Hospital for Sick Children (Kyong-Soon Lee). 44. Washington, Children's National Hospital (Billie Lou Short). 45. Wilmington, Nemours/Alfred I. duPont Hospital for Children (Kevin Sullivan). 46. Winston\u2013Salem, Brenner Children's Hospital (Cherrie Welch).

Keywords

Anastomosis
CHNC
Congenital anomaly
Neonate

ASJC Scopus subject areas

Surgery
Pediatrics, Perinatology, and Child Health

Access to Document

10.1016/j.jpedsurg.2024.162015

Cite this

Datta, A., Murthy, K., Zaniletti, I., Guner, Y., Padula, M. A., Grover, T. R., Zendejas, B., St Peter, S. D., Diaz-Miron, J., Speziale, M., Evans, J. R., & Berman, L. (2025). Anastomotic Leak and its Implications: A Multicenter Analysis of “Type C” Esophageal Atresia / Tracheo-esophageal fistula (EA/TEF). Journal of pediatric surgery, 60(2), Article 162015. https://doi.org/10.1016/j.jpedsurg.2024.162015

@article{ce05cf52df35454689cab242287cba56,

title = "Anastomotic Leak and its Implications: A Multicenter Analysis of “Type C” Esophageal Atresia / Tracheo-esophageal fistula (EA/TEF)",

abstract = "Purpose: Repair of type C esophageal atresia with tracheo-esophageal fistula (EA/TEF) may be complicated by esophageal anastomotic leak. Risk factors associated with leak and the impact of leak on inpatient outcomes remains uncertain. Our objectives are to estimate the associations between clinical factors and esophageal anastomotic leak and quantify the association of leak with length of stay (LOS) in infants who underwent repair of type C EA/TEF. Methods: Using the Children's Hospitals Neonatal Database (CHND), we identified infants with type C EA/TEF from 2021 to 2023. The main outcomes were anastomotic leak and LOS. Multivariable associations between patient and clinical factors and these outcomes were quantified using logistic regression (leak) and Cox proportional hazards modelling (LOS). Results: Among 365 infants at 36 centers, anastomotic leak occurred in 55 (15.1 %) infants, and thoracoscopic approach, lower birthweight, small for gestational age less than 10th percentile, male sex, staged repair, ventricular septal defect, and center were independently associated with leak (area under receiver operating curve = 0.853). Also, LOS was increased in infants with leak compared to those without [hazard ratio (HR): 0.655, 95 % CI = 0.431–0.996, p = 0.044], independent of birth weight, surgical approach, male sex, or VSD. The adjusted LOS demonstrated a 11-fold inter-center variation (p = 0.034). Conclusions: Several clinical and operative factors are associated with esophageal anastomotic leak in infants after type C EA/TEF repair. Leak significantly prolongs LOS. The magnitude of inter-center variability in LOS also suggests that identifying best practices could aid in improving patient care in this patient population. Type of study: Retrospective Comparative Study. Level of Evidence: III.",

keywords = "Anastomosis, CHNC, Congenital anomaly, Neonate",

author = "Ankur Datta and Karna Murthy and Isabella Zaniletti and Yigit Guner and Padula, {Michael A.} and Grover, {Theresa R.} and Benjamin Zendejas and {St Peter}, {Shawn D.} and Jose Diaz-Miron and Mark Speziale and Evans, {Jacquelyn R.} and Loren Berman",

note = "Publisher Copyright: {\textcopyright} 2024 Elsevier Inc.",

year = "2025",

month = feb,

doi = "10.1016/j.jpedsurg.2024.162015",

language = "English (US)",

volume = "60",

journal = "Journal of pediatric surgery",

issn = "0022-3468",

publisher = "W.B. Saunders",

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Datta, A, Murthy, K, Zaniletti, I, Guner, Y, Padula, MA, Grover, TR, Zendejas, B, St Peter, SD, Diaz-Miron, J, Speziale, M, Evans, JR & Berman, L 2025, 'Anastomotic Leak and its Implications: A Multicenter Analysis of “Type C” Esophageal Atresia / Tracheo-esophageal fistula (EA/TEF)', Journal of pediatric surgery, vol. 60, no. 2, 162015. https://doi.org/10.1016/j.jpedsurg.2024.162015

TY - JOUR

T1 - Anastomotic Leak and its Implications

T2 - A Multicenter Analysis of “Type C” Esophageal Atresia / Tracheo-esophageal fistula (EA/TEF)

AU - Datta, Ankur

AU - Murthy, Karna

AU - Zaniletti, Isabella

AU - Guner, Yigit

AU - Padula, Michael A.

AU - Grover, Theresa R.

AU - Zendejas, Benjamin

AU - St Peter, Shawn D.

AU - Diaz-Miron, Jose

AU - Speziale, Mark

AU - Evans, Jacquelyn R.

AU - Berman, Loren

PY - 2025/2

Y1 - 2025/2

N2 - Purpose: Repair of type C esophageal atresia with tracheo-esophageal fistula (EA/TEF) may be complicated by esophageal anastomotic leak. Risk factors associated with leak and the impact of leak on inpatient outcomes remains uncertain. Our objectives are to estimate the associations between clinical factors and esophageal anastomotic leak and quantify the association of leak with length of stay (LOS) in infants who underwent repair of type C EA/TEF. Methods: Using the Children's Hospitals Neonatal Database (CHND), we identified infants with type C EA/TEF from 2021 to 2023. The main outcomes were anastomotic leak and LOS. Multivariable associations between patient and clinical factors and these outcomes were quantified using logistic regression (leak) and Cox proportional hazards modelling (LOS). Results: Among 365 infants at 36 centers, anastomotic leak occurred in 55 (15.1 %) infants, and thoracoscopic approach, lower birthweight, small for gestational age less than 10th percentile, male sex, staged repair, ventricular septal defect, and center were independently associated with leak (area under receiver operating curve = 0.853). Also, LOS was increased in infants with leak compared to those without [hazard ratio (HR): 0.655, 95 % CI = 0.431–0.996, p = 0.044], independent of birth weight, surgical approach, male sex, or VSD. The adjusted LOS demonstrated a 11-fold inter-center variation (p = 0.034). Conclusions: Several clinical and operative factors are associated with esophageal anastomotic leak in infants after type C EA/TEF repair. Leak significantly prolongs LOS. The magnitude of inter-center variability in LOS also suggests that identifying best practices could aid in improving patient care in this patient population. Type of study: Retrospective Comparative Study. Level of Evidence: III.

AB - Purpose: Repair of type C esophageal atresia with tracheo-esophageal fistula (EA/TEF) may be complicated by esophageal anastomotic leak. Risk factors associated with leak and the impact of leak on inpatient outcomes remains uncertain. Our objectives are to estimate the associations between clinical factors and esophageal anastomotic leak and quantify the association of leak with length of stay (LOS) in infants who underwent repair of type C EA/TEF. Methods: Using the Children's Hospitals Neonatal Database (CHND), we identified infants with type C EA/TEF from 2021 to 2023. The main outcomes were anastomotic leak and LOS. Multivariable associations between patient and clinical factors and these outcomes were quantified using logistic regression (leak) and Cox proportional hazards modelling (LOS). Results: Among 365 infants at 36 centers, anastomotic leak occurred in 55 (15.1 %) infants, and thoracoscopic approach, lower birthweight, small for gestational age less than 10th percentile, male sex, staged repair, ventricular septal defect, and center were independently associated with leak (area under receiver operating curve = 0.853). Also, LOS was increased in infants with leak compared to those without [hazard ratio (HR): 0.655, 95 % CI = 0.431–0.996, p = 0.044], independent of birth weight, surgical approach, male sex, or VSD. The adjusted LOS demonstrated a 11-fold inter-center variation (p = 0.034). Conclusions: Several clinical and operative factors are associated with esophageal anastomotic leak in infants after type C EA/TEF repair. Leak significantly prolongs LOS. The magnitude of inter-center variability in LOS also suggests that identifying best practices could aid in improving patient care in this patient population. Type of study: Retrospective Comparative Study. Level of Evidence: III.

KW - Anastomosis

KW - CHNC

KW - Congenital anomaly

KW - Neonate

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ER -

Anastomotic Leak and its Implications: A Multicenter Analysis of “Type C” Esophageal Atresia / Tracheo-esophageal fistula (EA/TEF)

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