Association of operative approach with outcomes in neonates with esophageal atresia and tracheoesophageal fistula

Eric W. Etchill, Katherine A. Giuliano, Emily F. Boss, Daniel S. Rhee, Shaun M. Kunisaki

Research output: Contribution to journalArticlepeer-review


Purpose: We sought to evaluate the impact of thoracoscopic repair on perioperative outcomes in infants with esophageal atresia and tracheoesophageal fistula (EA/TEF). Methods: The American College of Surgeons National Surgical Quality Improvement Program pediatric database from 2014 to 2018 was queried for all neonates who underwent operative repair of EA/TEF. Operative approach based on intention to treat was correlated with perioperative outcomes, including 30-day postoperative adverse events, in logistic regression models. Results: Among 855 neonates, initial thoracoscopic repair was performed in 133 (15.6%) cases. Seventy (53%) of these cases were converted to open. Those who underwent thoracoscopic repair were more likely to be full-term (p = 0.03) when compared to those in the open repair group. There were no significant differences in perioperative outcome measures based on surgical approach except for operative time (thoracoscopic: 217 min vs. open: 180 min, p<0.001). A major cardiac comorbidity (OR 1.6, 95% CI 1.2–2.1; p = 0.003) and preoperative ventilator requirement (OR 1.4, 95% CI 1.0–1.9; p = 0.034) were the only risk factors associated with adverse events. Conclusions: Thoracoscopic neonatal repair of EA/TEF continues to be used sparingly, is associated with high conversion rates, and has similar perioperative outcomes when compared to open repair. Level of evidence: III

Original languageEnglish (US)
Pages (from-to)2172-2179
Number of pages8
JournalJournal of pediatric surgery
Issue number12
StatePublished - Dec 2021


  • Esophageal atresia
  • Minimally invasive surgery
  • National surgical quality improvement program
  • Thoracoscopic surgery
  • Tracheoesophageal fistula

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery


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