Outcomes of infants undergoing surgery for oesophageal atresia and trachea-oesophageal fistula at a tertiary referral hospital in Tanzania.

Oesophageal atresia (OA/TOF) is a neonatal surgical emergency with high mortality in low- and middle-income countries, where delayed diagnosis, pneumonia, and limited perioperative capacity contribute to poor outcomes. Contemporary data from Tanzania are scarce. This study assessed preoperative delays, in-hospital preoperative mortality, 14-day postoperative mortality, and associated factors among neonates with OA/TOF at a national referral hospital. A 10-year retrospective review (2012-2022) was conducted at Muhimbili National Hospital for neonates with OA/TOF. Descriptive statistics and bivariate associations with preoperative and postoperative mortality were done. Exact one-sample binomial tests compared observed 14-day survival in Waterston classes B and C with historical expected survival. Time-fixed binary logistic regression identified independent predictors of 14-day postoperative mortality. Preoperative mortality was associated with lower gestational age (p = 0.010), greater pneumonia severity (p = 0.009), and fewer completed investigations for associated anomalies (p = 0.027). Fourteen-day postoperative mortality was 82.7% (43/52). Survival in Waterston class B (18.2%) was significantly lower than expected (p < 0.001), while class C survival (15.8%) was significantly higher than expected (p < 0.001). Median postoperative survival was 6 days (95% CI 2.88-7.11). Survival did not differ by Waterston class, pneumonia severity, or birth-to-surgery timing. Surgery within the first week was associated with lower odds of 14-day mortality (aOR 0.34, 95% CI 0.12-0.97). OA/TOF outcomes in this setting are marked by substantial preoperative and postoperative mortality. This study adds new insight by quantifying where delays occur and showing that most mortality accumulates before and shortly after surgery, indicating system-level constraints similar to those reported across sub-Saharan Africa. Early surgery within the first week was a predictor of improved survival. These findings provide locally generated evidence to strengthen neonatal surgical and perioperative capacity.