Abstract：
BACKGROUND: Esophageal atresia/tracheoesophageal fistula (EA/TEF) is a congenital malformation that occurs in about 1 in 2500-4000 live births. After surgical repair, despite the lack of evidence supporting the routine use of postoperative esophagram, most surgeons report obtaining an esophagram prior to enteral feeding. We hypothesized that abnormal indicators in vital signs, drain characteristics, and chest radiograph (CXR) could be used to screen for anastomotic leak, thus reducing the need for a routine esophagram.
METHODS: A single institution, retrospective chart review of all patients born with EA with or without TEF between 2009 and 2022 was performed. Vital signs, postoperative CXR, chest drain characteristics, and esophagram results were analyzed for patients who underwent repair.
RESULTS: Forty-five patients who underwent EA/TEF repair were included in the study, and 40 patients had routine esophagram. Out of the twenty-two patients who had at least one abnormal indicator, 14 (64%) had an anastomotic leak. Seventeen patients (43%) had the absence of abnormalities of all three indicators, and none of these patients had an anastomotic leak (100% negative predictive value). Moreover, changes in drain characteristics and vital signs together presented high sensitivity (87.5%), specificity (90%), and negative predictive value (94%).
CONCLUSIONS: In the absence of abnormalities in vital signs, CXR, and drain characteristics in patients undergoing EA/TEF repair, routine esophagram can be safely avoided prior to enteral feeding. Abnormalities in drain characteristics and vital signs together were highly sensitive and specific for anastomotic leak, thus potentially eliminating the need for routine CXR and thereby minimizing radiation exposure and cost.
METHODS: A single institution, retrospective chart review of all patients born with EA with or without TEF between 2009 and 2022 was performed. Vital signs, postoperative CXR, chest drain characteristics, and esophagram results were analyzed for patients who underwent repair.
RESULTS: Forty-five patients who underwent EA/TEF repair were included in the study, and 40 patients had routine esophagram. Out of the twenty-two patients who had at least one abnormal indicator, 14 (64%) had an anastomotic leak. Seventeen patients (43%) had the absence of abnormalities of all three indicators, and none of these patients had an anastomotic leak (100% negative predictive value). Moreover, changes in drain characteristics and vital signs together presented high sensitivity (87.5%), specificity (90%), and negative predictive value (94%).
CONCLUSIONS: In the absence of abnormalities in vital signs, CXR, and drain characteristics in patients undergoing EA/TEF repair, routine esophagram can be safely avoided prior to enteral feeding. Abnormalities in drain characteristics and vital signs together were highly sensitive and specific for anastomotic leak, thus potentially eliminating the need for routine CXR and thereby minimizing radiation exposure and cost.
摘要：
背景：食管闭锁/气管食管瘘（EA/TEF）是一种先天性畸形，在2500-4000例活产中约有1例发生。手术修复后,尽管缺乏支持术后常规使用食道的证据，大多数外科医生报告在肠内喂养之前获得食道图。我们假设生命体征指标异常，排水特性,胸部X光片（CXR）可用于筛查吻合口漏，从而减少了常规食道的需要。
方法：单一机构，对2009年至2022年期间出生时伴或不伴TEF的所有EA患者进行回顾性图表回顾.生命体征,术后CXR,胸腔引流特性,并对接受修复的患者的食管造影结果进行分析.
结果：45例接受EA/TEF修复的患者被纳入研究，40例患者有常规食管。在22名至少有一个异常指标的患者中，14（64％）有吻合口漏。17例（43%）患者的三项指标均无异常，这些患者均未出现吻合口漏(100%阴性预测值).此外，排水特性和生命体征的变化共同表现出高灵敏度(87.5%)，特异性（90%），阴性预测值（94%）。
结论：在没有生命体征异常的情况下，CXR,接受EA/TEF修复的患者的引流特性，在肠内喂养之前可以安全地避免常规食道。引流管特征和生命体征的异常对吻合口漏高度敏感和特异，从而潜在地消除了对常规CXR的需要,从而使辐射暴露和成本最小化。
方法：单一机构，对2009年至2022年期间出生时伴或不伴TEF的所有EA患者进行回顾性图表回顾.生命体征,术后CXR,胸腔引流特性,并对接受修复的患者的食管造影结果进行分析.
结果：45例接受EA/TEF修复的患者被纳入研究，40例患者有常规食管。在22名至少有一个异常指标的患者中，14（64％）有吻合口漏。17例（43%）患者的三项指标均无异常，这些患者均未出现吻合口漏(100%阴性预测值).此外，排水特性和生命体征的变化共同表现出高灵敏度(87.5%)，特异性（90%），阴性预测值（94%）。
结论：在没有生命体征异常的情况下，CXR,接受EA/TEF修复的患者的引流特性，在肠内喂养之前可以安全地避免常规食道。引流管特征和生命体征的异常对吻合口漏高度敏感和特异，从而潜在地消除了对常规CXR的需要,从而使辐射暴露和成本最小化。
