Evaluation of factors influencing

morbidity and mortality in cases

of oesophageal atresia and/or
tracheo-oesophageal fistula
repair

Presented by: Rajan Kumar

AIMS AND OBJECTIVES

• Evaluate the factors influencing

morbidity and mortality in cases of
OA with or without TOF repair.
• Know the Preoperative,Intraoperative
and Postoperative causes
responsible for poor outcome of
operation.
• This study can help us to improve
outcome in OA with or without TOF
cases in future.
STUDY DESIGN

• No. of cases:- • 30

• Duration of • July 2006 to

study:- September 2008
• Preparation of patients
Patients should be prepared for surgery
with stabilization of vitals , infection
and correction of sugar or
electrolyte abnormalities.
OBSERVATION

Distribution of cases according to Sex

S. No Sex No of patients No of Survivals

No % No %

1 Male 15 50 3 20
2 Female 15 50 5 34
Total 30 100 8
1 Male
2 Female
 Birth Weight
(Kg)
S. No Birth weight No of patients No of Survivals
(Kg)
No % No %

1 1.5 to 2.0 18 60 5 28

2 2.0 to 2.5 7 23 2 29
3 >2.5 5 17 1 20

Total 30 100 8
 Distribution of cases according to Age group (hours)

S. No Time No of patients No of Survivals

(hours)
No % No %

1 <24 7 23 2 29

2 24-48 8 27 4 50
3 >48 15 50 2 13
Total 30 100 8
 Distribution of cases according to Gestational age

S. No GA No of patients No of Survivals

No % No %

1 Full 25 83 8 32
term
2 Preterm 5 17 0 0

Total 30 100 8
 Associated congenital anomalies (27%)

S. No Associated anomalies No of patients No of Survivals

No % No %

1 Anorectal malformation 4 13.3 0 0

2 Cardiac anomaly 3 10 0 0

3 Other gastrointestinal 1 3 0 0
anomalies
4 Renal anomalies 2 6 0 0

5 VACTERL anomalies 4 13.3 0 0

6 Hypospadias (Penoscrotal) 1 3 0 0

7 Right sided aortic arch 2 6 0 0

 Pneumonia (Clinical and Radiological) at presentation

S. No Pneumonia No of patients No of Survivals

No % No %

1 Present 19 63 0 0
2 Absent 11 37 8 73

Total 30 100 8
 Sepsis at presentation

S. No Sepsis No of patients No of Survivals

No % No %

1 Present 8 27 0 0
2 Absent 22 73 8 36
Total 30 100 8
 Type of OA / TOF

S. No Type No of patients No of Survivals

No % No %

1 III b/C 20 83 5 25

2 II / A 3 13 3 100

3 Oeseophageal 1 3 0 0
web
Total 30 100 8
Gap between proximal and distal oesophageal segments

S. No GAP No of patients No of Survivals

No % No %

1 Long 9 37 4 44

2 Short 15 63 4 27

Total 24 100 8
 Post operative sepsis
S. No Post operative No of patients No of Survivals
sepsis

No % No %

1 Present 16 67 0 0

2 Absent 8 33 8 100
Total 24 100 8
 Main cause of death
S. No Cause of No of patients No of Survivals
Death

No % No %

1 Sepsis 21 100 0 0
Total 21 100 0 0
 Cause of sepsis

S. No Cause of sepsis No of patients No of Survivals

No % No %

1 Pneumonia 16 76 0 0

2 Anastomotic leak 05 24 0 0

Total 21 100 0
 After applying Waterston criteria results are

S.No. Group No of Survival

patients

No %

1 Group – A 6 6 100
2 Group – B 15 2 16

3 Group – C 09 00 00
Total 30 08
 Overall result in total no. of patients

3
27

70

Survival Death LAMA

 Overall result in total No of operated patients

34

66

Survival Death
The factors which lead to high
morbidity and mortality are
• Sepsis at time of presentation or
acquired during hospitalisation.
• Pneumonitis at presentation or
acquired during hospitalization.
• Associated congenital anomalies
• Long gap in between the proximal
and distal oesophageal segments
• Anastomotic leaks.
• Low birth weight
• Delayed diagnosis
• Delayed referrel.
• Low socioeconomic status
• Lack of advanced neonatological
backup
INFERENCE
• Promotion of trained labour
• Newborn examination
• Early diagnosis
• Prompt referrel
• Proper newborn care
• Appropriate operation
• Neonatal icu care
• With the joint effort of the persons
starting from PHC level to TERTIARY
level the outcome of oesophageal
atresia and/or tracheo-esophageal
fistula will improve.