Document Detail


A new prognostic classification for esophageal atresia.
MedLine Citation:
PMID:  8456399     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Waterston's risk categories have been extensively used in the past for the classification and management of neonates with esophageal atresia. Advances in neonatal care have affected the prognostic usefulness of the Waterston classification. The purpose of this study is to formulate a new classification of risk factors that would more accurately predict outcome. METHODS: We retrospectively reviewed 95 consecutive cases of esophageal atresia and/or tracheoesophageal fistula treated at the Montreal Children's Hospital. Fifteen patients were in the Waterston class A, with a 6.7% mortality; 35 patients, in class B with a 5.7% mortality; and 45 patients, in class C with a 26.7% mortality. Logistic regression analysis of the influence of each risk factor (weight, pulmonary status, and severity of associated anomalies) on mortality was performed. RESULTS: Birth weight was not found to independently influence mortality. Only severe pulmonary dysfunction with preoperative ventilator dependence and severe associated anomalies had a prognostic influence. We therefore revised the classification to include only significant factors. The new high-risk class II consists of patients with either life-threatening anomalies or both major anomalies and ventilator dependence; the low-risk class I includes all other patients. These criteria radically changed the stratification of both the number of cases and the mortality among classes: the 82 patients in class I had a 7.3% mortality; the 13 patients in class II had a 69.2% mortality. Logistic regression analysis confirmed the validity of this new classification by showing displacement of individual variables by the revised classification but not by Waterston's. CONCLUSIONS: This new "Montreal classification" can simplify and improve the stratification of patients with esophageal atresia. It also reflects the more favorable outcome of low birth weight neonates.
Authors:
D Poenaru; J M Laberge; I R Neilson; F M Guttman
Related Documents :
19427429 - Ability of retinopathy to predict cardiovascular disease in patients with type 2 diabet...
8774829 - Variability of ventricular premature complexes and mortality risk.
19427449 - Relation of aortic valve and coronary artery calcium in patients with chronic kidney di...
15615819 - Serum phosphate levels and mortality risk among people with chronic kidney disease.
17941909 - Increased long-term cardiovascular morbidity among patients treated with radioactive io...
17667579 - Transesophageal echocardiography and cardiovascular sources of embolism: implications f...
9365329 - Incidental pituitary macroadenoma: a population-based study.
3309469 - Primary adenocarcinoma of the appendix: report of five cases and review of the literature.
6375759 - Incidence of acute graft-versus-host disease with and without methotrexate prophylaxis ...
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Surgery     Volume:  113     ISSN:  0039-6060     ISO Abbreviation:  Surgery     Publication Date:  1993 Apr 
Date Detail:
Created Date:  1993-04-20     Completed Date:  1993-04-20     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  0417347     Medline TA:  Surgery     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  426-32     Citation Subset:  AIM; IM    
Affiliation:
Department of General Surgery, Montreal Children's Hospital, McGill University, Quebec, Canada.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Abnormalities, Multiple / classification*,  mortality
Birth Weight
Esophageal Atresia / classification*,  mortality
Female
Humans
Infant, Newborn
Male
Prognosis
Risk Factors
Tracheoesophageal Fistula / classification*,  mortality

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Management of arterial injuries produced by percutaneous femoral procedures.
Next Document:  Effects of lumbar sympathectomy on canine transcutaneous oxygen tension.