Determinants of in-hospital mortality among neonates with esophageal atresia and tracheoesophageal fistula: a retrospective study from Ethiopia

Esophageal atresia with tracheoesophageal fistula (EA/TEF) is a life-threatening congenital anomaly requiring early surgical repair. Postoperative survival varies substantially between high-income and low-resource settings. Evidence identifying determinants of postoperative outcomes in Ethiopia remains limited. To determine the magnitude of postoperative mortality and identify predictors of in-hospital outcomes among neonates undergoing surgery for EA/TEF. A retrospective cross-sectional study was conducted at Tikur Anbessa Specialized Hospital between February 2019 and March 2023. Medical records of 122 operated neonates with EA/TEF were reviewed. The primary outcome was survival status at discharge (alive vs. died). Postoperative outcomes assessed included in-hospital mortality, postoperative complications, reoperation, and causes of death. Bivariate and multivariable logistic regression analyses were performed to identify independent predictors of mortality. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were reported. Among 122 operated neonates, 62 (50.8%) died and 60 (49.2%) were discharged alive. Overall, 105 (86.1%) developed at least one postoperative complication, with hospital-acquired infections being the most frequent (53.3%). Sepsis (28.7%) and postoperative apnea (17.2%) were the leading causes of death. In multivariable analysis, preoperative electrolyte abnormalities (AOR: 0.081, 95% CI: 0.007–0.887, p = 0.040) and the occurrence of at least one postoperative complication was significantly associated with in-hospital mortality (AOR: 0.126, 95% CI: 0.052–0.303, p < 0.001). Postoperative mortality among neonates with EA/TEF in our setting was high (50.8%), with more than four-fifths developing postoperative complications. Preoperative electrolyte abnormalities and postoperative complications were significant predictors of death. Strengthening preoperative metabolic optimization and improving postoperative infection prevention and monitoring strategies are critical to improving survival in resource-limited neonatal surgical settings.