title: A nationwide analysis of clinical outcomes among newborns with esophageal atresia and tracheoesophageal fistulas in the United States.
abstract: BACKGROUND
  The aim of this study was to examine national outcomes in newborn patients with esophageal atresia and tracheoesophageal fistula (EA/TEF) in the United Sates.
  
  
  METHODS
  Kids' Inpatient Database (KID) is designed to identify, track, and analyze national outcomes for hospitalized children in the United States. Inpatient admissions for pediatric patients with EA/TEF for kids' Inpatient Database years 2000, 2003, 2006, and 2009 were analyzed. Patient demographics, socioeconomic measures, disposition, survival and surgical procedures performed were analyzed using standard statistical methods.
  
  
  RESULTS
  A total of 4168 cases were identified with diagnosis of EA/TEF. The overall in-hospital mortality was 9%. Univariate analysis revealed lower survival in patients with associated acute respiratory distress syndrome, ventricular septal defect (VSD), birth weight (BW) < 1500 g, gestational age (GA), time of operation within 24 h of admission, coexisting renal anomaly, imperforate anus, African American race, and lowest economic status. Multivariate logistic regression identified BW < 1500 g (odds ratio [OR] = 4.5, P < 0.001), operation within 24 h (OR = 6.9, P < 0.001), GA <28 wk (OR = 2.2, P < 0.030), and presence of VSD (OR = 3.8, P < 0.001) as independent predictors of in-hospital mortality. Children's general hospital and children's unit in a general hospital were found to have a lower mortality rate compared with not identified as a children's hospital after excluding immediate transfers (P = 0.008).
  
  
  CONCLUSIONS
  BW < 1500 g, operation within 24 h, GA < 28 wk, and presence of VSD are the factors that predict higher mortality in EA/TEF population. Despite dealing with more complicated cases, children's general hospital and children's unit in a general hospital were able to achieve a lower mortality rate than not identified as a children's hospital.
authors.affiliation: Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Bo
authors.initials: B
authors.lastname: Wang
authors.affiliation: Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Jun
authors.initials: J
authors.lastname: Tashiro
authors.affiliation: Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Bassan J
authors.initials: BJ
authors.lastname: Allan
authors.affiliation: Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Juan E
authors.initials: JE
authors.lastname: Sola
authors.affiliation: Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Punam P
authors.initials: PP
authors.lastname: Parikh
authors.affiliation: Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Hogan
authors.affiliation: Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Holly L
authors.initials: HL
authors.lastname: Neville
authors.affiliation: Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida. Electronic address: eperez3@med.miami.edu.
authors.forename: Eduardo A
authors.initials: EA
authors.lastname: Perez
mesh_terms: D001741:Black or African American / Q000208:ethnology; D044466:Asian People / Q000208:ethnology; D004933:Esophageal Atresia / Q000191:economics / Q000208:ethnology / Q000401:mortality*; D005260:Female; D006630:Hispanic or Latino / Q000208:ethnology; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D044468:Native Hawaiian or Pacific Islander / Q000208:ethnology; D012189:Retrospective Studies; D014138:Tracheoesophageal Fistula / Q000191:economics / Q000208:ethnology / Q000401:mortality*; D014481:United States / Q000453:epidemiology / Q000208:ethnology
keywords: Birth weight; Esophageal atresia; Hospital types; KID; Kid Inpatient Database; Mortality; Socioeconomic; TEF/EA; Tracheoesophageal fistula; VSD