Dr. Adriana Dekirmendjian - Best of the Best in Pediatric Surgery 2025

We're going to move on to the final paper of this heat, another paper from Caps and also diaphragmatic hernia. So there must be a lot of diaphragmatic hernias uh in Canada. Uh so we have uh Dr. Adriana uh Decker Majon, who's going to be talking about congenital diaphragmatic hernia in Canada, time trends and analysis by location, maternal age and sex and she's coming from the Hospital for Sick Children in Toronto, Canada. Good afternoon and thank you for the opportunity to present our study entitled incidence of congenital diaphragmatic hernia in Canada. Time trends and analysis by location, maternal age and sex. My name is Adriana Degen and I'm a general surgery resident representing the Hospital for sick children as well as the University of Toronto. The authors of this study have no conflicts of interest to disclose. As we know, congenital diaphragmatic hernia is a relatively rare birth defect with significant short as well as long-term sequele. A systematic review performed by our group demonstrated that the incidence of CDH varies significantly between regions and populations with a global overall incidence of 2.3 per 10,000 births. This study not only provided key insights into the epidemiology of CDH worldwide, but it highlighted the fact that there are no national Canadian epidemiological studies examining CDH. As such, the aim of this study was to determine and report the incidence of CDH in Canada and its provinces and territories by year and putative risk factors. In order to do this, we utilized the congenital anomalies report on CDH, which was informed by the Canadian Institute of Health Information discharge abstract database from 2006 to 2020, as well as Quebec's equivalent, the Med Echo from 2008 to 2020. CDH cases were identified by use of the validated ICD 10 code Q79.0. Of note, Kai high Dad included both live and still births, whereas the Meta Echo database only included live births. Terminations were excluded from both databases and there were was no distinction between isolated versus complex CDH nor laterality. Incidence rates were calculated as the number of cases of CDH per 10,000 births with birth data obtained from Statistics Canada. Cases were reported and analyzed by province, year, sex and maternal age. And differences in proportions and rates were analyzed using chi-squared tests and Poson regression. We also calculated incidence rate ratios and 95% confidence intervals assuming the following reference values: a maternal age of 25 to 29, male fetal sex and Ontario as the provincial reference. We observed that the Canadian incidence of CDH from 2006 to 2020 was 2.71 per 10,000 births. Our examination of incidence rates by province found that Manitoba had the highest incidence of CDH, followed by Nova Scotia and Sawan. In comparison to the reference province Ontario, Manitoba had a significantly higher incidence of CDH and demonstrated an incidence rate ratio of 1.33. We also observed a preponderance of male sex amongst cases with 58% of patients being assigned male sex at birth. Although there were subtle variations in incidence from 2006 to 2020, we did not observe a significant difference in incidence over time. However, when examining incidence of CDH by maternal age, we found that an advanced maternal age, specifically maternal age 40 plus was associated with an increased rate of CDH and had an incidence rate ratio of 1.68. We acknowledge that this study is not without limitations. Specifically, we were limited in our use of aggregate versus patient level data, and as a result, we were unable to control for the various co-variates and subsequently could not determine independence of associations. Additionally, administrative data such as that used for this study is limited in terms of what is collected and is also subject to misclassification and imputation errors. However, despite these limitations, we were able to determine that the Canadian incidence of CDH was 2.71 per 10,000 births, and to our knowledge, this represents the first national study examining CDH incidence in Canada. We also found that incidence rates vary by region and confirm that similar to other populations, male fetal sex and older maternal age are associated with an increased incidence of CDH. Future directions for this work include use of national clinical databases as well as administrative databases such as the Canadian neonatal Network database, the Canadian pediatric surgery Network database and the Canadian Institute for Health Information database to determine true incidence, risk factors and patient outcomes. Thank you very much for your time and attention. So great presentation. Thank you very much. Um you know, there are always challenges with administrative databases and interpreting the data. But any any hypothesis on what's going on in Manitoba and specifically did you look at are there does that region have an increased incidence of other congenital anomalies? So that's an an excellent question. Um, we did try to evaluate what is in the water in Manitoba. Um, as I stated in the presentation, unfortunately because this was aggregate data, we weren't able to control specifically for those other factors. But when we look at um basically the statistics Canada uh trends and what they put out, we see that in Manitoba there isn't an an overall increased uh maternal age like that so we don't think that that's what's at play necessarily. But there definitely are some environmental factors which we think are associated. Um, we also believe that in Manitoba specifically, there's a difference in the ethnic makeup in comparison to other parts of Canada. And so although we're unable to state that that's the reason, our group has hypothesized that obviously there's an interplay between genetic, environmental and then some socio-demographic um influences as well. And uh to your point about the other congenital anomalies, there was actually a paper that was um published by Lou at Al looking at gastrosis, which is another similar somewhat similar congenital anomaly and they also found that there was an increased incidence in Manitoba. And um, more so they actually saw this north to south variation, which was very interesting. So the northern regions of the province actually had an increased incidence of gasis. And so again, we think that that's probably related to um the communities that settle in the northern regions as well as access to prenatal care um and some of those prenatal exposures. Very helpful. Obviously lots of uh opportunity for more work there. Yes. Yeah. Awesome. Thank you so much. Paper. So I think we're going to go to the voting now. Um, so um, we had the four papers. Um, we had the CAM K2G promotes neuronal differentiation in neuroblastoma, the safety evaluation of Providone iodine for perforated appendicitis, the sided to sided to and CDH and the CDH demographics in Canada. and let's see how things are going here. Any uh, I don't know if any of the faculty, anyone of these stuck out. It was it was astonishing to me, the referral patterns in Manitoba are astonishing and something to study because it's uh um it really does dictate a lot of the things you're presenting. Um, all right, so are we ready to call it yet? Um, we're pretty tight between um, let's see, what do we got? So 39 and 27. So I think I think uh Dr. Sutik, it seems at this point, now these can change and we'll let you know, we'll update you. Uh it looks like your paper uh has won the heat but by a very narrow margin and uh um but uh congratulations. Um, everyone loves to talk about appendicitis. Absolutely, thank you. It's all about appendicitis. So uh all right, well thank you guys so much. Uh can stick around. Congratulations.