Long-term surgical outcomes in congenital diaphragmatic hernia

observations from a single institution

Tim Jancelewicz, Lan T. Vu, Roberta L. Keller, Barbara Bratton, Hanmin Lee, Diana L Farmer, Michael Harrison, Doug Miniati, Tippi Mackenzie, Shinjiro Hirose, Kerilyn Nobuhara

Research output: Contribution to journalArticle

72 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)155-160
Number of pages6
JournalJournal of Pediatric Surgery
Volume45
Issue number1
DOIs
StatePublished - Jan 2010

Fingerprint

Thorax
Survivors
Recurrence
Hernia
Multivariate Analysis
Kaplan-Meier Estimate
Scoliosis
Odds Ratio
Regression Analysis
Confidence Intervals
Oxygen
Congenital Diaphragmatic Hernias
Liver
Incidence

Keywords

  • CDH
  • Congenital diaphragmatic hernia
  • Long-term surgical outcomes
  • Patch repair

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Long-term surgical outcomes in congenital diaphragmatic hernia : observations from a single institution. / Jancelewicz, Tim; Vu, Lan T.; Keller, Roberta L.; Bratton, Barbara; Lee, Hanmin; Farmer, Diana L; Harrison, Michael; Miniati, Doug; Mackenzie, Tippi; Hirose, Shinjiro; Nobuhara, Kerilyn.

In: Journal of Pediatric Surgery, Vol. 45, No. 1, 01.2010, p. 155-160.

Research output: Contribution to journalArticle

Jancelewicz, T, Vu, LT, Keller, RL, Bratton, B, Lee, H, Farmer, DL, Harrison, M, Miniati, D, Mackenzie, T, Hirose, S & Nobuhara, K 2010, 'Long-term surgical outcomes in congenital diaphragmatic hernia: observations from a single institution', Journal of Pediatric Surgery, vol. 45, no. 1, pp. 155-160. https://doi.org/10.1016/j.jpedsurg.2009.10.028
Jancelewicz, Tim ; Vu, Lan T. ; Keller, Roberta L. ; Bratton, Barbara ; Lee, Hanmin ; Farmer, Diana L ; Harrison, Michael ; Miniati, Doug ; Mackenzie, Tippi ; Hirose, Shinjiro ; Nobuhara, Kerilyn. / Long-term surgical outcomes in congenital diaphragmatic hernia : observations from a single institution. In: Journal of Pediatric Surgery. 2010 ; Vol. 45, No. 1. pp. 155-160.
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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.",
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AU - Jancelewicz, Tim

AU - Vu, Lan T.

AU - Keller, Roberta L.

AU - Bratton, Barbara

AU - Lee, Hanmin

AU - Farmer, Diana L

AU - Harrison, Michael

AU - Miniati, Doug

AU - Mackenzie, Tippi

AU - Hirose, Shinjiro

AU - Nobuhara, Kerilyn

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N2 - 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.

AB - 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.

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KW - Congenital diaphragmatic hernia

KW - Long-term surgical outcomes

KW - Patch repair

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