Esophageal atresia in Bremen, Germany - Evaluation of preoperative risk classification in esophageal atresia

Background/Purpose: The current study enrolled 113 patients with esophageal atresia (EA) accompanying tracheoesophageal fistula (TEF) (Vogt type IIIb) who were treated at the Central Hospital St. Jurgen Strasse, Department of Pediatric Surgery in Bremen, Germany between 1978 and 1997. Methods: These EA patients were classified into patients preoperatively com plicated by respiratory distress syndrome (RDS) or pneumonia and those with out complications. In each group, risk factors were classified according to the risk classification described by Spitz et al, and the prognoses and th erapeutic problems were evaluated. Based on these results, a new preoperati ve risk classification consisting of risk factors described by Spitz et al supplemented with RDS and pneumonia was evaluated. Results: When the prognoses of EA were evaluated, the survival rate was mar kedly decreased when RDS or pneumonia alone or more than 2 of 3 factors inc luding major cardiac a noma lies a nd low birth weight were present as preo perative risk factors. Concerning therapeutic problems, the necessity of tr eatment with delayed primary repair tended to increase when RDS or pneumoni a was present as risk factors. However, it was suggested that secure and sa fe blockage of TEF was still difficult during the initial surgery. Conclusions: During selection of therapeutic strategies for EA, RDS and pne umonia are still considered to be essential as preoperative risk factors fo r EA. Our new preoperative risk classification consisting of risk factors d escribed by Spitz et al supplemented with RDS and pneumonia appears to clea rly reflect the prognoses and therapeutic problems of EA. Copyright (C) 200 0 by W.B. Saunders Company.