Risk factors for postoperative anastomotic leakage after repair of esophageal atresia: a retrospective nationwide database study
Risk factors for postoperative anastomotic leakage after repair of esophageal atresia: a retrospective nationwide database study
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食管闭锁修复术后吻合口瘘的危险因素：全国回顾性数据库研究
DOI：
10.1007/s00595-023-02682-0
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发表时间：
2023
期刊：
影响因子：
2.5
通讯作者：
Yasunaga H
中科院分区：
文献类型：
--
作者：
Ishimaru T;Shinjo D;Fujiogi M;Michihata N;Morita K;Hayashi K;Tachimori H;Kawashima H;Fujishiro J;Yasunaga H
目的术后吻合口漏是新生儿食道闭锁修补术最常见的短期并发症。本研究使用日本全国外科数据库来确定新生儿食道闭锁修补术中吻合口瘘的危险因素。方法在国家临床数据库中对2015-2019年间诊断为食道闭锁的新生儿进行鉴定。术后吻合口漏患者之间的比较，以确定潜在的危险因素，使用单因素分析。多因素Logistic回归分析包括性别、胎龄、胸腔镜术、分期修补术、手术时间等因素。结果本组病例共667例，漏发生率为7.8%(n= 52)。分期修补者发生吻合口瘘的可能性高于未行修补者(分别为21.2%和5.2%)，手术时间为 <； 3.5h的患者比手术时间为3.5h的患者更有可能发生吻合口瘘(分别为12.6%和3.0%；p<； 0.001)。多因素Logistic回归分析显示，分期修复(优势比[OR]4.89，95%可信区间[CI]2.22~10.16，p<； 0.001)和较长的手术时间(OR 4.65，95%CI 2.38~9.95，p<； 0.001)是术后吻合口漏的危险因素。结论分期手术和较长的手术时间与术后吻合口瘘的发生有关，提示复杂食道闭锁修补术后发生吻合口瘘的可能性较大，需要改进治疗策略。
PurposePostoperative anastomotic leakage is the most frequent short-term complication of esophageal atresia repair in neonates. We conducted this study using a nationwide surgical database in Japan to identify the risk factors for anastomotic leakage in neonates undergoing esophageal atresia repair.MethodsNeonates diagnosed with esophageal atresia between 2015 and 2019 were identified in the National Clinical Database. Postoperative anastomotic leakage was compared among patients to identify the potential risk factors, using univariate analysis. Multivariable logistic regression analysis included sex, gestational age, thoracoscopic repair, staged repair, and procedure time as independent variables.ResultsWe identified 667 patients, with an overall leakage incidence of 7.8% (n= 52). Anastomotic leakage was more likely in patients who underwent staged repairs than in those who did not (21.2% vs. 5.2%, respectively) and in patients with a procedure time > 3.5 h than in those with a procedure time < 3.5 h (12.6% vs. 3.0%, respectively;p< 0.001). Multivariable logistic regression analysis identified staged repair (odds ratio [OR] 4.89, 95% confidence interval [CI] 2.22–10.16,p< 0.001) and a longer procedure time (OR 4.65, 95% CI 2.38–9.95,p< 0.001) as risk factors associated with postoperative leakage.ConclusionStaged procedures and long operative times are associated with postoperative anastomotic leakage, suggesting that leakage is more likely after complex esophageal atresia repair and that such patients require refined treatment strategies.