Comparison of outcomes between thoracostomy and non-thoracostomy management in patients undergoing esophageal atresia surgery: a retrospective study in a tertiary care center (2018–2021)

Esophageal atresia (EA) is a rare yet critical congenital anomaly requiring prompt surgical intervention. The necessity of routine chest tube placement during EA repair remains controversial, particularly in neonates vulnerable to procedure-related complications. This study aimed to evaluate clinical outcomes associated with thoracostomy versus non-thoracostomy management in neonates undergoing EA repair. In this retrospective descriptive-analytical study, 79 neonates treated for EA at Shahid Motahari Pediatric Hospital (Urmia, Iran) between 2018 and 2021 were included. Patients were categorized into thoracostomy (n = 27) and non-thoracostomy (n = 52) groups. Data on demographics, ventilation duration, NICU stay, postoperative pneumonia, pneumothorax, and mortality were analyzed using univariate and multivariate statistical methods. Baseline characteristics were comparable between groups. The thoracostomy group exhibited significantly longer NICU stays [median (IQR) 20 (12–31) vs. 13 (9–20) days; p = 0.022] and higher pneumothorax incidence (40.7% vs. 3.8%; p < 0.001). Mechanical ventilation duration showed a non-significant trend toward longer duration in the thoracostomy group [median (IQR) 6 (4–12) vs. 4 (2–8) days; p = 0.053]. No significant differences were observed in pneumonia rates (11.1% vs. 11.5%; p = 0.947) or mortality (22.2% vs. 25.0%; p = 0.508). Multivariate logistic regression identified thoracostomy as a strong independent predictor of pneumothorax (adjusted OR = 22.56; 95% CI: 4.19-121.39; p < 0.001), with no significant association with pneumonia or mortality. Routine chest tube placement in neonatal EA repair was associated with increased morbidity, particularly higher pneumothorax risk and prolonged NICU stay, without benefits in preventing pneumonia or reducing mortality. These findings argue against routine use and support a selective, individualized approach. Prospective multicenter studies are needed to establish evidence-based guidelines for thoracostomy in this high-risk population.