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Factors associated with early recurrence after congenital diaphragmatic hernia repair.

Abstract：

BACKGROUND:The purpose of this study was to identify patient and treatment characteristics associated with early (in hospital) hernia recurrence after congenital diaphragmatic hernia (CDH) repair. METHODS:Data from the Congenital Diaphragmatic Hernia Study Group registry were queried from 2007 to 2015. Recurrence of the diaphragmatic hernia after initial repair and prior to death or discharge was determined at the time of reoperation. Minimally invasive surgery (MIS) approaches included laparoscopy or thoracoscopy, and open approaches consisted of laparotomy or thoracotomy. Multivariate regression analysis was performed. RESULTS:Of 3984 patients, 3332 (84%) underwent CDH repair. 76 (2.3%) patients had an early recurrence. The rate of recurrence was less variable over time for patients undergoing laparotomy vs thoracoscopy (range: 1.1-3.7% vs 1.7-8.9% annually). Timing of repair, whether performed after, during, or before ECMO did not significantly alter recurrence rates (0% vs 4.2% vs 3.0%, p=0.116). Larger defect size (C: OR 4.3, 95% CI 1.2-15.4; D: OR 7.1, 95% CI 1.7-29.1) and an MIS approach (OR 3.2, 95% CI 1.7-6.0) were the only independent predictors of recurrence. CONCLUSION:Larger defect size and an MIS approach were associated with higher rates of early recurrence, while ECMO use and timing of repair with ECMO were not. TYPE OF STUDY:Treatment study. LEVEL OF EVIDENCE:II.

journal_name

J Pediatr Surg

journal_title

Journal of pediatric surgery

authors

Putnam LR,Gupta V,Tsao K,Davis CF,Lally PA,Lally KP,Harting MT,Congenital Diaphragmatic Hernia Study Group.

doi

10.1016/j.jpedsurg.2017.03.011

subject

Has Abstract

pub_date

2017-06-01 00:00:00

pages

928-932

issue

6

eissn

0022-3468

issn

1531-5037

pii

S0022-3468(17)30160-4

journal_volume

52

pub_type

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