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February 28, 2026Open Access

Comparison of outcomes between thoracostomy and non-thoracostomy management in patients undergoing esophageal atresia surgery: a retrospective study in a tertiary care center (2018–2021)

Key Points

This study evaluates the clinical outcomes of routine thoracostomy versus non-thoracostomy management in neonates undergoing surgical repair for esophageal atresia.
Conducted a retrospective analysis of 79 neonates with esophageal atresia between 2018 and 2021.
Categorized patients into thoracostomy and non-thoracostomy groups.
Analyzed data on demographics, ventilation duration, NICU stay, postoperative pneumonia, pneumothorax, and mortality.
Used univariate and multivariate statistical methods for analysis.
Thoracostomy group had longer median NICU stays (20 days vs. 13 days, p = 0.022).
Higher incidence of pneumothorax in the thoracostomy group (40.7% vs. 3.8%, p < 0.001).
No significant differences in pneumonia rates (11.1% vs. 11.5%, p = 0.947) or mortality (22.2% vs. 25.0%, p = 0.508).
Thoracostomy was a strong predictor of pneumothorax (adjusted OR = 22.56; p < 0.001).

Abstract

Esophageal atresia (EA) is a rare yet critical congenital anomaly requiring prompt surgical intervention. The necessity of routine chest tube placement during EA repair remains controversial, particularly in neonates vulnerable to procedure-related complications. This study aimed to evaluate clinical outcomes associated with thoracostomy versus non-thoracostomy management in neonates undergoing EA repair. In this retrospective descriptive-analytical study, 79 neonates treated for EA at Shahid Motahari Pediatric Hospital (Urmia, Iran) between 2018 and 2021 were included. Patients were categorized into thoracostomy (n = 27) and non-thoracostomy (n = 52) groups. Data on demographics, ventilation duration, NICU stay, postoperative pneumonia, pneumothorax, and mortality were analyzed using univariate and multivariate statistical methods. Baseline characteristics were comparable between groups. The thoracostomy group exhibited significantly longer NICU stays median (IQR) 20 (12–31) vs. 13 (9–20) days; p = 0.022 and higher pneumothorax incidence (40.7% vs. 3.8%; p < 0.001). Mechanical ventilation duration showed a non-significant trend toward longer duration in the thoracostomy group median (IQR) 6 (4–12) vs. 4 (2–8) days; p = 0.053. No significant differences were observed in pneumonia rates (11.1% vs. 11.5%; p = 0.947) or mortality (22.2% vs. 25.0%; p = 0.508). Multivariate logistic regression identified thoracostomy as a strong independent predictor of pneumothorax (adjusted OR = 22.56; 95% CI: 4.19-121.39; p < 0.001), with no significant association with pneumonia or mortality. Routine chest tube placement in neonatal EA repair was associated with increased morbidity, particularly higher pneumothorax risk and prolonged NICU stay, without benefits in preventing pneumonia or reducing mortality. These findings argue against routine use and support a selective, individualized approach. Prospective multicenter studies are needed to establish evidence-based guidelines for thoracostomy in this high-risk population.

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