P-14: The Mortality of Oesophageal Atresia: Results from 726 Patients (1970-2013).

The majority of oesophageal atresia (OA) patients survive through to adulthood. However, a significant minority will die, either early post-natally or later in childhood (often unexpectedly). To establish the rate of mortality in our OA cohort, with emphasis upon associated factors that may predict patient demise. Prospectively maintained databases were used to determine the rate and associations of mortality in patients born after 1969. Two cohorts (historical [1970–89], contemporary [1990–2013]) were further analysed. 726 patients were studied, of which 135 (19%) died during the 44-year period. The mortality rate of the historical cohort (84/330, 25%) was halved in the contemporary cohort (51/396, 13%). This was associated with increased numbers of syndromic patients in the historical cohort (28/84, 33%) (trisomy 21 [n = 6], trisomy 18 [n = 13]) versus the contemporary cohort (11/51, 22%) (trisomy 21 [n = 3], trisomy 18 [n = 4]). The association between VACTERL and mortality was identical in the cohorts (historical −31/84 [37%], contemporary −19/51 [37%]). The decision not to operate was more common in the historical cohort (38/330 [12%] versus 14/396 [4%]) and represented 45% of historical deaths compared with 27% of contemporary deaths. The mortality rate in patients with OA is higher than previously reported. Historically patients were more often palliated, commonly in the setting of an associated syndrome.