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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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.
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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