ONE YEAR OUTCOMES OF CONGENITAL DIAPHRAGMATIC HERNIA REPAIR: FACTORS ASSOCIATED WITH RECURRENCE AND COMPLICATIONS
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Read the article on jpedsurg.org ↗Article · Sep 2020 · 1 min read
In brief
In brief
Nationwide study of 511 neonatal CDH repairs found 97% readmission rate within one year, most commonly for reflux complications and hernia recurrence. Minimally invasive repair showed significantly higher recurrence (48%) versus open approaches (16%), challenging current surgical practice patterns.
Written by the GCMD Library team from the article.
Abstract
Purpose
Congenital diaphragmatic hernia (CDH) is a congenital anomaly associated with lifelong multisystem morbidity. This study sought to identify factors contributing to hospital readmission after CDH repair.
Methods
The Nationwide Readmissions Database from 2010 to 2014 was used to identify patients with CDH who underwent surgical repair. Primary outcomes included all cause readmission at 30-days and 1 year and readmission for hernia recurrence. Patient and hospital factors were compared using chi-squared analysis.
Results
Five hundred eleven patients were identified with neonatal CDH. All repairs were performed at teaching hospitals via laparotomy in 59% (n = 303), thoracotomy in 36% (n = 183), and minimally invasive (MIS) repair in 5% (n = 25). The readmission rate within 30-days was 32% (n = 163), and 97% (n = 495) within 1 year. The most common conditions surrounding readmission were for gastroesophageal reflux (20%), CDH recurrence (17%), and surgery for gastrostomy tube and/or fundoplication (16%). Recurrence was significantly higher after MIS repair (48%) compared to those with open repair via either approach (16%), p < 0.001.
Conclusions
This is the first study to evaluate nationwide readmissions in newborns with CDH. Readmission is commonly due to CDH recurrence and reflux-associated complications. The recurrence rate is higher than previously reported and is more common after MIS and repair via thoracotomy.
Level of evidence
Level III treatment study.