Measurement of gap length in esophageal atresia: a simple predictor of outcome.
BACKGROUND
Previous classifications of esophageal atresia (EA) and tracheoesophageal fistula (TEF) have concentrated on associated medical conditions that influence survival. We propose a classification based on gap lengths to define the magnitude of the surgical problems in EA and TEF and correlate them with outcome.


METHODS
Gaps between the esophageal ends were classified as long (greater than 3 cm), intermediate (greater than 1 cm but less than or equal to 3 cm) or short (less than or equal to 1 cm). A series of 66 consecutive patients with EA and TEF were studied.


RESULTS
The outcomes of patients with long (n = 16), intermediate (n = 16), and short (n = 34) gaps were respectively: death (18 percent, 6 percent, 3 percent), anastomotic leak (31 percent, 25 percent, 6 percent), stricture (44 percent, 31 percent, 17 percent), recurrent TEF (6 percent, 6 percent, 6 percent), gastroesophageal reflux (56 percent, 37 percent, 36 percent), and failure to thrive (56 percent, 43 percent, 18 percent). The mean hospital stay at first admission was (97, 54, 24 days, respectively) and the mean number of readmissions was (6.9, 5.2, 3.4, respectively).


CONCLUSIONS
This classification, which is based on easily measurable criteria, provides a useful method to predict morbidity, long-term outcome, and health costs associated with EA and TEF surgery.
University of Oxford, John Radcliffe Hospital, United Kingdom.
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D000886:Anthropometry / Q000379:methods; D002675:Child, Preschool; D004933:Esophageal Atresia / Q000145:classification* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D010359:Patient Readmission; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome