Predictors of Respiratory Admission After Tracheoesophageal Fistula Repair: A 10-year Review (2013-2023)

Introduction: Pediatric patients with tracheoesophageal fistula (TEF) often suffer from recurrent pulmonary illnesses, usually attributed to concomitant tracheomalacia. Patient population was reviewed to determine frequency and factors predisposing to respiratory illnesses warranting hospital admission.

Methods: Study used retrospective cohort of TEF patients repaired at Children’s National Hospital from 2013–2023. Abstracted EMR data included surgical approach and postoperative outcomes. Preliminary chi-square and t-tests identified potential risk factors for respiratory readmission.

Results: 64 infants underwent TEF surgical repair (Type C:87.5%, Type E:6.3%: Type B:4.7% Type D:1.5%). Mean gestational age was 36.8 weeks and 36% were preterm ( < 37 weeks). Comorbidities included cardiac (31.2%), neurologic (3.1%) and genetic conditions (12.5%). Repairs were open (79.7 %) or thoracoscopic (20.3%). Nearly 40% (24/64) underwent at least one direct laryngoscopy and bronchoscopy and 24.6% were referred to aerodigestive clinic (ADC).

Mean follow up was 1486 days (range:75-3552); Nearly half (43.8%) of subjects were admitted at least once for respiratory illness and 26.5% admitted >2 times.

Predictors of >1 respiratory admission included longer OR time at primary repair (p=0.043), esophageal stricture (p=0.021) delayed esophageal anastomosis (p=0.017), g-tube dependency (p=0.036), ADC referral (p=0.003) and tracheomalacia (p=0.00007) .

Factors not predicting respiratory admission included prematurity (p=0.622), cardiac, genetic or neurologic comorbidities (p=0.341, 0.703, 0.253 respectively), type of repair (open vs laparoscopic), p=0.411), or fundoplication procedure (p=0.446).

Conclusions: Nearly half (43.8%) of patients with TEF required a subsequent hospital admission for respiratory illnesses and 25% two or more admissions. In addition to tracheomalacia, patients experiencing prolonged OR time at primary repair, esophageal stricture, and g-tube dependency are at high risk and may benefit from early intervention and possible aortopexy for prevention of serious respiratory sequelae.