Abstract：
BACKGROUND: Following surgical correction, many patients with esophageal atresia with or without tracheoesophageal fistula (EA/TEF) present to the emergency department (ED) with acute airway complications. We sought to determine the incidence and risk factors for severe acute life-threatening events (ALTEs) in pediatric patients with repaired congenital EA/TEF and the outcomes of operative interventions.
METHODS: A retrospective cohort chart review was performed on patients with EA/TEF with surgical repair and follow-up at a single centre from 2000 to 2018. Primary outcomes included 5-year ED visits and/or hospitalizations for ALTEs. Demographic, operative, and outcome data were collected. Chi-square tests and univariate analyses were performed.
RESULTS: In total, 266 EA/TEF patients met inclusion criteria. Of these, 59 (22.2%) had experienced ALTEs. Patients with low birth weight, low gestational age, documented tracheomalacia, and clinically significant esophageal strictures were more likely to experience ALTEs (p < 0.05). ALTEs occurred prior to 1 year of age in 76.3% (45/59) of patients with a median age at presentation of 8 months (range 0-51 months). Recurrence of ALTEs after esophageal dilatation was 45.5% (10/22), mostly due to stricture recurrence. Patients experiencing ALTEs received anti-reflux procedures (8/59, 13.6%), airway pexy procedures (7/59, 11.9%), or both (5/59, 8.5%) within a median age of 6 months of life. The resolution and recurrence of ALTEs after operative interventions are described.
CONCLUSIONS: Significant respiratory morbidity is common among patients with EA/TEF. Understanding the multifactorial etiology and operative management of ALTEs have an important role in their resolution.
METHODS: Original Research, Clinical Research.
METHODS: Level III Retrospective Comparative Study.
METHODS: A retrospective cohort chart review was performed on patients with EA/TEF with surgical repair and follow-up at a single centre from 2000 to 2018. Primary outcomes included 5-year ED visits and/or hospitalizations for ALTEs. Demographic, operative, and outcome data were collected. Chi-square tests and univariate analyses were performed.
RESULTS: In total, 266 EA/TEF patients met inclusion criteria. Of these, 59 (22.2%) had experienced ALTEs. Patients with low birth weight, low gestational age, documented tracheomalacia, and clinically significant esophageal strictures were more likely to experience ALTEs (p < 0.05). ALTEs occurred prior to 1 year of age in 76.3% (45/59) of patients with a median age at presentation of 8 months (range 0-51 months). Recurrence of ALTEs after esophageal dilatation was 45.5% (10/22), mostly due to stricture recurrence. Patients experiencing ALTEs received anti-reflux procedures (8/59, 13.6%), airway pexy procedures (7/59, 11.9%), or both (5/59, 8.5%) within a median age of 6 months of life. The resolution and recurrence of ALTEs after operative interventions are described.
CONCLUSIONS: Significant respiratory morbidity is common among patients with EA/TEF. Understanding the multifactorial etiology and operative management of ALTEs have an important role in their resolution.
METHODS: Original Research, Clinical Research.
METHODS: Level III Retrospective Comparative Study.
摘要：
背景：手术矫正后，许多伴有或不伴有气管食管瘘（EA/TEF）的食管闭锁患者因急性气道并发症出现在急诊科（ED）。我们试图确定先天性EA/TEF修复的儿科患者严重急性危及生命事件（ALTEs）的发生率和危险因素以及手术干预的结果。
方法：对2000年至2018年在单中心进行手术修复和随访的EA/TEF患者进行了回顾性队列研究。主要结果包括5年ED访视和/或ALTE住院。人口统计,Operative,并收集结果数据。进行卡方检验和单变量分析。
结果：总计，266例EA/TEF患者符合纳入标准。其中,59人（22.2%）经历过ALTE。低出生体重患者，低胎龄，有记录的气管软化,临床上显着的食管狭窄更容易发生ALTE（p<0.05）。76.3％（45/59）的患者中，ALTE发生在1岁之前，中位年龄为8个月（范围0-51个月）。食管扩张后ALTEs的复发率为45.5%(10/22),主要是由于狭窄复发。接受ALTE的患者接受了抗反流程序（8/59，13.6％），气道疼痛程序（7/59，11.9％），或两者（5/59，8.5％）在中位年龄6个月内。描述了手术干预后ALTE的消退和复发。
结论：在EA/TEF患者中常见显著的呼吸道并发症。了解ALTE的多因素病因和手术管理对其解决具有重要作用。
方法：原始研究，临床研究。
方法：III级回顾性对比研究。
方法：对2000年至2018年在单中心进行手术修复和随访的EA/TEF患者进行了回顾性队列研究。主要结果包括5年ED访视和/或ALTE住院。人口统计,Operative,并收集结果数据。进行卡方检验和单变量分析。
结果：总计，266例EA/TEF患者符合纳入标准。其中,59人（22.2%）经历过ALTE。低出生体重患者，低胎龄，有记录的气管软化,临床上显着的食管狭窄更容易发生ALTE（p<0.05）。76.3％（45/59）的患者中，ALTE发生在1岁之前，中位年龄为8个月（范围0-51个月）。食管扩张后ALTEs的复发率为45.5%(10/22),主要是由于狭窄复发。接受ALTE的患者接受了抗反流程序（8/59，13.6％），气道疼痛程序（7/59，11.9％），或两者（5/59，8.5％）在中位年龄6个月内。描述了手术干预后ALTE的消退和复发。
结论：在EA/TEF患者中常见显著的呼吸道并发症。了解ALTE的多因素病因和手术管理对其解决具有重要作用。
方法：原始研究，临床研究。
方法：III级回顾性对比研究。
