APSA Papers
Long-term surgical outcomes in congenital diaphragmatic hernia: observations from a single institution

https://doi.org/10.1016/j.jpedsurg.2009.10.028Get rights and content

Abstract

Background/Purpose

Surgical complications are common in survivors of congenital diaphragmatic hernia (CDH), but little is known about long-term incidence patterns and associated predictors.

Methods

A cohort of 99 CDH survivors was prospectively followed at a single-institution multidisciplinary clinic. Data were gathered regarding the adverse surgical outcomes of hernia recurrence, chest and spinal deformity, and operative small bowel obstruction (SBO), and then were retrospectively analyzed in relation to perinatal and perioperative markers of disease severity to determine significant predictors. Statistical methods used included univariate and multivariate regression analysis, hazard modeling, and Kaplan-Meier analysis.

Results

At a median cohort age of 4.7 (range, 0.2-10.6) years, 46% of patients with patch repairs and 10% of those with primary repairs had a hernia recurrence at a median time of 0.9 (range, 0.1-7.3) years after repair. Chest deformity was detected in 47%. Small bowel obstruction and scoliosis occurred in 13%. Recurrence and chest deformity were significantly more common with patch repair, liver herniation, age at neonatal extubation greater than 16 days, oxygen requirement at discharge, and prematurity. The strongest predictor of SBO was patch repair. Multivariate analysis showed that patch repair was independently predictive of recurrence and early chest deformity (odds ratios of 5.0 and 4.8, confidence intervals of 1-24 and 1-21, P < .05). Use of an absorbable patch was associated with the highest risk of surgical complications.

Conclusions

For long-term survivors of CDH, specific perinatal and operative variables, particularly patch repair, are associated with subsequent adverse surgical outcomes.

Section snippets

Methods

Permission for this study was obtained from the Committee on Human Research of the University of California, San Francisco (UCSF), H11258-30536-01.

Cohort characteristics

General cohort characteristics are presented in Table 1. There was 1 postdischarge death occurring in a 21-month-old boy owing to delayed transfer to UCSF for management of volvulus. For the purposes of statistical analysis, perinatal predictors of adverse surgical outcomes were given the following binary classifications: patch vs primary repair, liver herniation vs no herniation, age at extubation greater or less than 16 days (cohort median), neonatal discharge with or without oxygen

Discussion

Surgical complications are common among CDH survivors, but data are limited regarding long-term incidence patterns and associated risk factors [4], [5], [7], [8], [12], [13], [14], [15], [16]. As with the adverse medical outcomes of neurodevelopmental delay, hearing loss, pulmonary insufficiency, and growth and nutritional failure, adverse surgical outcomes seem to be most frequent in those patients with a large CDH defect requiring patch repair. In keeping with existing reports, in our cohort

References (22)

  • WeberT.R. et al.

    Improved survival in congenital diaphragmatic hernia with evolving therapeutic strategies

    Arch Surg

    (1998)
  • Cited by (0)

    Presented at the 40th Annual Meeting of the American Pediatric Surgical Association, Fajardo, Puerto Rico, May 28-June 1, 2009.

    View full text