Since my doctor was out on vacation this week, I was mainly able to research on my projection –a five decade review on esophageal atresia with and without trachioesophageal fistula.
Esophageal atresia (EA)/trachioesophageal fistula (TEF) is a congenital disease that involves a failure of the development of the esophagus. Normally the esophagus (connects the mouth to the stomach) and trachea (connects the mouth to the lungs) are separate pipes; but in EA/TEF these pipes are underdeveloped and/or connecting. The failure in separating is pinpointed to the fourth fetal week when the trachea and esophagus should start to divide.
About 85% of all EA/TEF cases have an esophagus that ends in a blind pouch and a trachea that connects to the proximal portion of the esophagus. This part is called esophageal atresia. Trachioesophageal fistula is defined when the distal esophagus (one coming from the stomach) connects to the distal trachea. There are many other types of EA/TEF, some with only EA and no fistulas. Some cases involve EA with both proximal and distal TEFs -meaning the lower esophagus connects to both the upper and lower trachea. Other cases may involve an EA with proximal TEF but no distal TEF.
The first reported case was reported in 1670 but a successful intervention did not occur until 1941. After the successful operation, the mortality rate for EA/TEF decreased exponentially. The risk factors for survival previous to 1995 and after 1941 were mainly weight and other complications. Now, after 1995, weight is no longer an issue as ICU, surgical and anesthetic techniques have advanced greatly. Cardiac and other complications remain an issue as it sometimes prevents emergency surgical intervention; cardiac complications arise in 30% of all cases.
My project involves statistical analysis on all the cases of EA/TEF in the New York Presbyterian hospital during five decades. The decades are divided into three eras -1960 to 1974, 1975 to 1995 and 1995 to 2007. We are interested in seeing if there is a statistical difference in mortality, morbidity, and other complication rates between eras. We also plan to perform follow up calls to patients from different eras to see what post operative care is still needed many years later.
From what I’ve calculated, there is no statistical significance in terms of mortality, morbidity, complication between eras despite improvement in patient care, neonatal intensive care advances and surgical advances. The data set could possibly be bias and I’m looking into this factor in the upcoming weeks.