Risk factors for prolonged ICU stay following congenital oesophageal Atresia surgery: a retrospective study

To investigate risk factors for prolonged intensive care unit (ICU) stay after surgery for congenital oesophageal atresia (OA), with or without tracheo-oesophageal fistula (TOF). This retrospective study enrolled infants who underwent surgical repair for congenital OA. Patients were divided into two groups (prolonged and control group) based on the length of their ICU stay. A prolonged ICU stay was defined as exceeding the 75th percentile of the cohort. Multivariable logistic regression analysis was employed to identify the independent risk factors for a prolonged ICU stay. A receiver operating characteristic (ROC) curve was then used to evaluate the predictive value of these risk factors. Between June 2017 and September 2024, 177 infants underwent OA/TOF repair. Of these, 173 met the inclusion criteria after exclusions were applied. The median ICU stay was 13 days (IQR 9–24 days), with 44 patients classified as having a prolonged ICU stay. Univariate analysis identified 15 potential predictors of ICU stay, while multivariate logistic regression analysis revealed 3 independent risk factors for prolonged ICU stay: gestational age (OR: 0.705, 95% CI: 0.594–0.837, p < 0.001), the presence of other congenital anomalies (OR: 6.087, 95% CI: 2.564–14.451, p < 0.001), and early postoperative severe hypoalbuminaemia (OR: 5.183, 95% CI: 1.494–17.979, p = 0.01). ROC curve analysis showed that combining these factors provided a good prediction of prolonged ICU stay after surgery, with an AUC of 0.835 (95% CI: 0.758–0.913). This study identified the independent risk factors for a prolonged ICU stay following OA/TOF repair. These results may enable clinicians to implement earlier interventions to reduce risks and prevent delayed recovery.