Analysis of risk factors for postoperative complications after repair of esophageal atresia using a nationwide database

2023 Fiscal Year Final Research Report

• Project/Area Number: 21K08609
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Review Section: Basic Section 55010:General surgery and pediatric surgery-related
• Research Institution: National Center for Child Health and Development (2022-2023); Saitama Children's Medical Center (2021)
• Principal Investigator: Ishimaru Tetsuya 国立研究開発法人国立成育医療研究センター, 小児外科系専門診療部, 診療部長 (00633629)
• Co-Investigator(Kenkyū-buntansha): 道端 伸明 千葉県がんセンター(研究所), がん予防センター 予防疫学研究室, 室長 (00415598) ; 林 健太郎 埼玉県立小児医療センター (臨床研究部), 外科, 医員 (40814900) ; 藤代 準 東京大学, 医学部附属病院, 教授 (60528438) ; 川嶋 寛 埼玉県立小児医療センター (臨床研究部), 外科, 副部長 (80447408)
• Project Period (FY): 2021-04-01 – 2024-03-31
• Keywords: 大規模データベース / 食道閉鎖症 / リスク因子解析 / 術後合併症

Outline of Final Research Achievements

The aim of this study was to identify risk factors for anastomotic leakage in patients who underwent esophageal atresia repair using a nationwide surgical database in Japan. We identified 667 neonates in the National Clinical Database diagnosed with esophageal atresia from 2015 to 2019. Postoperative anastomotic leakage was compared between patients to identify potential risk factors using univariate analysis. Multivariable logistic regression analysis included sex, gestational age, thoracoscopic repair, staged repair, and procedure time as independent variables. As a result, an overall leakage incidence was 7.8% (n=52). Multivariable logistic regression analysis identified staged repair (odds ratio [OR] 3.52, 95% confidence interval [CI] 1.54-7.61, p<0.001) and longer procedure time (OR 4.01, 95% CI 2.02-8.68, p<0.001) as factors associated with postoperative leakage.

Free Research Field

小児外科

Academic Significance and Societal Importance of the Research Achievements

本邦の食道閉鎖症の術後成績は過去の文献と比較して同等であることが分かった．また，手術困難症例が示唆される多段階手術と長時間手術が術後縫合不全のリスク因子であることも分かった．困難な症例では縫合不全が起きやすく，より慎重な対応が求められるということを明らかにした．