Implementation and Evaluation of a Protocol for the Management of Type C Tracheoesophageal Fistula

IF 1.6 3区医学 Q2 SURGERY

Journal of Surgical Research Pub Date : 2026-03-01 Epub Date: 2026-02-10 DOI:10.1016/j.jss.2026.01.010

Sage A. Vincent MD , Lori Silveira PhD, MS , Samantha Bothwell MS , Jonathan Roach MD , Jose Diaz-Miron MD, MSCS , Stephanie L. Bourque MD, MSCS , Shannon N. Acker MD

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引用次数: 0

Abstract

Introduction

A multidisciplinary protocol for the management of esophageal atresia/tracheoesophageal fistula (EA/TEF) was developed with stakeholders from pediatric surgery and neonatology. Introduced in July 2022, this study aims to assess protocol utilization and association with patient outcomes.

Methods

We performed a single-center, retrospective review of neonatal patients who underwent type C EA/TEF repair between 2010 and 2024. Utilization of protocol elements was assessed, as well as clinical outcomes. Preprotocol and postprotocol management and outcomes were compared using logistic regression. A prospective provider survey was administered to assess protocol sustainability and knowledge.

Results

There were 103 patients who underwent type C EA/TEF repair, 87 preprotocol and 16 postprotocol implementation. Thoracoscopic repair was more common postprotocol (68.8% versus 31.0%, P = 0.003). Patients were more likely to receive total parenteral nutrition until full enteral feeds were reached (odds ratio 75.6; 95% confidence interval 4.2, 1445; P = 0.003) and receive enteral feeds within 24 h of surgery when transanastomotic tube was in place (odds ratio 3.71; 95% confidence interval 1.04, 13.27; P = 0.043) postprotocol. There was no significant change in outcomes including anastomotic leak and stricture. Providers could correctly identify 2/3 of the EA/TEF protocol elements and 22% reported receiving education on its contents.

Conclusions

Implementation of an EA/TEF protocol was associated with a 75 times greater likelihood of patients receiving total parenteral nutrition until full feeds were reached and 3.7 times greater likelihood of starting enteral feeds within 24 h of surgery when transanastomotic tube was in place. There was a shift toward thoracoscopic repair of EA/TEF and no change in clinical outcomes including anastomotic leak and stricture. Implementation and knowledge of the protocol faced challenges and provider surveys identified avenues for improving education strategies.

查看原文本刊更多论文

C型气管食管瘘治疗方案的实施与评价。

来自儿科外科和新生儿科的利益相关者制定了一项多学科的食管闭锁/气管食管瘘（EA/TEF）治疗方案。该研究于2022年7月推出，旨在评估方案的使用及其与患者预后的关联。方法：我们对2010年至2024年间接受C型EA/TEF修复的新生儿患者进行了单中心回顾性研究。评估方案要素的使用情况以及临床结果。采用逻辑回归比较方案前和方案后的管理和结果。对潜在提供者进行调查，以评估协议的可持续性和知识。结果：103例患者行C型EA/TEF修复，方案前87例，方案后16例。术后胸腔镜修复更为常见（68.8%比31.0%,P = 0.003）。患者接受全肠外营养的可能性更大，直到完全肠内喂养（优势比75.6；95%可信区间4.2,1445;P = 0.003），术后24小时内放置吻合口管后接受肠内喂养的可能性更大（优势比3.71；95%可信区间1.04,13.27;P = 0.043）。吻合口瘘和狭窄等预后无明显变化。提供者可以正确识别2/3的EA/TEF协议元素，22%的人报告接受了有关其内容的教育。结论：实施EA/TEF方案与患者接受全肠外营养的可能性增加75倍，直到达到全喂养的可能性增加3.7倍，在手术后24小时内开始肠内喂养，经吻合口管到位。手术转向胸腔镜下修复EA/TEF，临床结果无变化，包括吻合口漏和狭窄。协议的实施和知识面临挑战，提供者调查确定了改进教育战略的途径。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Surgical Research 医学-外科

CiteScore

3.90

自引率

4.50%

发文量

627

审稿时长

138 days

期刊介绍： The Journal of Surgical Research: Clinical and Laboratory Investigation publishes original articles concerned with clinical and laboratory investigations relevant to surgical practice and teaching. The journal emphasizes reports of clinical investigations or fundamental research bearing directly on surgical management that will be of general interest to a broad range of surgeons and surgical researchers. The articles presented need not have been the products of surgeons or of surgical laboratories. The Journal of Surgical Research also features review articles and special articles relating to educational, research, or social issues of interest to the academic surgical community.