Esophageal atresia with tracheoesophageal fistula and early postoperative mortality.
BACKGROUND
Several recent reports showed that associated anomalies represent the main cause of postoperative mortality in infants born with esophageal atresia (EA) and/ or tracheoesophageal fistula (TEF) Our observations present additional causes of mortality to the above mentioned. The aim of this study is to identify the major causes of early postoperative mortality in cases of EA and/or TEF in our setup. The ongoing preoperative classifications predicting mortality will be also used for comparison.


METHODS
We reviewed 101 charts of all cases with EA and/or TEF in a period of 11 years from 1990 to 2000. Morbidity and causes of postoperative mortality during the first admissions were identified. The factors predicting mortality were documented. Patients were classified according to Waterston, Montreal and Spitz classifications.


RESULTS
Thirty-one patients (30.7%) died. Two main groups of post operative mortality were identified. The first group included the possibly avoidable causes of mortality which were primary sepsis (n=10, 32.3%), technical problems (n=8, 25.8%) and severe pneumonia (n=5, 16.1%). The unavoidable causes of mortality included major congenital anomalies (n=6, 19.3%) and anomalies incompatible with life (n=2, 6.5%).


CONCLUSIONS
Primary sepsis and sepsis due to technical problems were the main causes of mortality in our series. Factors predicting mortality were pneumonia at presentation, sepsis at presentation or that acquired during hospitalization, major or life threatening anomalies, long gaps and major leaks. The Waterston classification was statistically the best applicable in this study.
Al-Malki
Talal A
TA
College of Medicine & Medical Sciences, Taif University-Taif and Department of Pediatric Surgery, Aseer Central Hospital, Abha, Saudi Arabia. taam_tm@yahoo.com
Ibrahim
Ashraf H
AH
D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D004933:Esophageal Atresia / Q000150:complications / Q000401:mortality* / Q000601:surgery; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008485:Medical Audit; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality*; D012307:Risk Factors; D012529:Saudi Arabia; D018805:Sepsis / Q000209:etiology* / Q000401:mortality; D016019:Survival Analysis; D013997:Time Factors; D014138:Tracheoesophageal Fistula / Q000150:complications / Q000401:mortality* / Q000601:surgery