Comparison of Mortality Classifications and Prediction of Morbidity Risk Factors in Esophageal Atresia/Tracheoesophageal Fistula Patients

Objective:The aim of the study is to compare the mortality rates in cases with esophageal atresia/ tracheoesophageal fistula (EA/TEF) using Spitz and Okamoto prognostic classifications as the predictive power of the presence of major cardiac anomalies alone, and to reveal specific risk factor indicators predicting early-stage postoperative morbidities.Method: Archive files of the patients with the diagnosis of EA/TEF admitted between between January 2000 and May 2020 were retrospectively reviewed.Archive files of the patients were reviewed in terms of their demographic information, disease characteristics, the surgeries they had undergone, postoperative outcomes, early complications, and morbidities developed during follow-up and secondary surgical interventions.Morbidities were divided into three groups as gastrointestinal, respiratory, and developmental complications. Results:The Okamoto and Spitz classifications were valid in predicting mortality, but the Okamoto classification provided statistically more significant prognostic data.The presence of major cardiac anomalies alone was not significant in predicting mortality.All morbidities were found to be at a higher rate in cases with prematurity and in the presence of accompanying congenital syndrome.The time to removal of postoperatively inserted thoracic and nasogastric tubes, length of hospital stay, and duration of postoperative mechanical ventilation were positively correlated with the development of all morbidities.Anastomotic leakage and development of recurrent fistula were found to worsen especially respiratory morbidities.However, among all morbidities, long-gap EA was not a significant risk factor. Conclusion:The presence of a major cardiac anomaly, regardless of birth weight, is insufficient to predict mortality.Although Okamoto and Spitz classifications remain valid for predicting mortality, Okamoto classification was a more powerful predictor of mortality.Knowing morbidity-specific risk factors for each of them will guide the follow-up of EA/TEF patients in order to reduce the incidence rates of gastrointestinal, respiratory, and developmental morbidities.