Impacts of surgical interventions on the long-term outcomes in individuals with trisomy 18
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In brief
In brief
Retrospective multicenter study of 69 trisomy 18 patients showing that cardiac and digestive surgical interventions significantly improved rates of achieving homecare (p=0.02) but did not extend long-term survival. Findings suggest surgery may facilitate hospital discharge and family-centered care rather than prolonging life in this population.
Written by the GCMD Library team from the article.
Abstract
Objective
We aim to clarify whether surgical interventions can contribute to improve the long-term outcomes among individuals with trisomy 18.
Methods
We retrospectively studied 69 individuals with trisomy 18 admitted to 4 tertiary neonatal centers between 2003 and 2017. A cohort was divided into two groups: subjects with surgical interventions and conservative treatments. We compared the rates of survival and achieving homecare between the groups.
Results
Gestational age and birth weight were 37 (27–43) weeks and 1,700 (822–2,546) g, respectively. There were 68 patients with congenital heart disease and 20 patients with digestive disease. Surgical interventions including cardiac and digestive surgery were provided in 41% of individuals. There was no difference in gestational age (p=0.30), birth weight (p=0.07), gender (p=0.30), and fetal diagnosis (p=0.87) between the groups. During the median follow up duration of 51 (2–178) months, overall survival rates in 6, 12 and 60 months were 57%, 43% and 12%, respectively. Survival to hospital discharge occurred in 23 patients, and the rates of achieving homecare in 1, 6, and 12 months are 1%, 18% and 30%, respectively. There was no significant difference in survival rate (p=0.26) but in the rate of achieving home care (p=0.02) between the groups. Cox hazard analysis revealed that prenatal diagnosis (hazard ratio 0.30, 95%CI: 0.13–0.75), cardiac surgery (hazard ratio 2.40, 95%CI:,1.03–5.55), and digestive surgery (hazard ratio 1.20, 95%CI: 1.25–3.90) were related to the rate of achieving homecare.
Conclusion
Aggressive surgical interventions contribute not to the long-term survival but to achieve homecare among individuals with trisomy 18.
Evidence Level
Level 3 (Prognostic study, Case-Control study)