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Risk factors for postoperative anastomotic leakage after repair of esophageal atresia: a retrospective nationwide database study

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Abstract

Purpose

Postoperative anastomotic leakage is the most frequent short-term complication of esophageal atresia repair in neonates. We conducted this study using a nationwide surgical database in Japan to identify the risk factors for anastomotic leakage in neonates undergoing esophageal atresia repair.

Methods

Neonates diagnosed with esophageal atresia between 2015 and 2019 were identified in the National Clinical Database. Postoperative anastomotic leakage was compared among patients to identify the potential risk factors, using univariate analysis. Multivariable logistic regression analysis included sex, gestational age, thoracoscopic repair, staged repair, and procedure time as independent variables.

Results

We identified 667 patients, with an overall leakage incidence of 7.8% (n = 52). Anastomotic leakage was more likely in patients who underwent staged repairs than in those who did not (21.2% vs. 5.2%, respectively) and in patients with a procedure time > 3.5 h than in those with a procedure time < 3.5 h (12.6% vs. 3.0%, respectively; p < 0.001). Multivariable logistic regression analysis identified staged repair (odds ratio [OR] 4.89, 95% confidence interval [CI] 2.22–10.16, p < 0.001) and a longer procedure time (OR 4.65, 95% CI 2.38–9.95, p < 0.001) as risk factors associated with postoperative leakage.

Conclusion

Staged procedures and long operative times are associated with postoperative anastomotic leakage, suggesting that leakage is more likely after complex esophageal atresia repair and that such patients require refined treatment strategies.

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Data availability

The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.

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Acknowledgements

This work was supported by a Grant-in-Aid for Scientific Research (C) from the Ministry of Education, Culture, Sports, Science, and Technology, Japan (No. 21K08609).

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Authors and Affiliations

  1. Department of Pediatric Surgery, Saitama Children’s Medical Center, 1-2 Shintoshin, Chuo-Ku, Saitama, 330-8777, Japan

    Tetsuya Ishimaru & Hiroshi Kawashima

  2. Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan

    Daisuke Shinjo

  3. Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Daisuke Shinjo & Hisateru Tachimori

  4. Department of Surgical Specialties, Division of Surgery, National Center for Child Health and Development, Tokyo, Japan

    Michimasa Fujiogi

  5. Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan

    Michimasa Fujiogi & Hideo Yasunaga

  6. Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Nobuaki Michihata

  7. Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Kaori Morita, Kentaro Hayashi & Jun Fujishiro

  8. Endowed Course for Health System Innovation, Keio University School of Medicine, Tokyo, Japan

    Hisateru Tachimori

Authors
  1. Tetsuya Ishimaru
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  2. Daisuke Shinjo
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  3. Michimasa Fujiogi
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  4. Nobuaki Michihata
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  5. Kaori Morita
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  6. Kentaro Hayashi
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  7. Hisateru Tachimori
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  8. Hiroshi Kawashima
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  9. Jun Fujishiro
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  10. Hideo Yasunaga
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Contributions

All authors contributed to the conception and design of the study. Tetsuya Ishimaru, Shinjo Daisuke, Michimasa Fujiogi, and Nobuaki Michihata prepared the material, collected the data, and conducted the analysis. Tetsuya Ishimaru wrote the first draft of the manuscript and all authors commented on the previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Tetsuya Ishimaru.

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Ishimaru, T., Shinjo, D., Fujiogi, M. et al. Risk factors for postoperative anastomotic leakage after repair of esophageal atresia: a retrospective nationwide database study. Surg Today 53, 1269–1274 (2023). https://doi.org/10.1007/s00595-023-02682-0

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  • DOI: https://doi.org/10.1007/s00595-023-02682-0

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