Thoracoscopic repair of neonatal congenital diaphragmatic hernia (CDH): Outcomes after a systematic quality improvement process

Abstract Background Higher recurrence rates have been reported for thoracoscopic repair (TR) of neonatal congenital diaphragmatic hernia (CDH) compared to open repair. Our centre initiated changes in surgical management following a quality review in order to improve outcome. Methods A retrospective...

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Bibliographic Details
Published in:Journal of pediatric surgery 2013-02, Vol.48 (2), p.321-325
Main Authors: Jancelewicz, Tim, Langer, Jacob C, Chiang, Monping, Bonnard, Arnaud, Zamakhshary, Mohammed, Chiu, Priscilla P
Format: Article
Language:English
Subjects:
CDH
Congenital diaphragmatic hernia
Endosurgical
Female
Hernia, Diaphragmatic - surgery
Hernias, Diaphragmatic, Congenital
Humans
Infant, Newborn
Male
Minimally invasive
Outcomes
Pediatrics
Quality Improvement
Recurrence
Retrospective Studies
Surgery
Thoracoscopic repair
Thoracoscopy - standards
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Summary:Abstract Background Higher recurrence rates have been reported for thoracoscopic repair (TR) of neonatal congenital diaphragmatic hernia (CDH) compared to open repair. Our centre initiated changes in surgical management following a quality review in order to improve outcome. Methods A retrospective review of TR patients from 2000 to 2011 at a single institution was performed. A review was done in 2007, and changes were implemented to decrease recurrence rates. These included use of pledgets, an extracorporeal corner stitch, liberal prosthetic patch use, lower insufflation pressures, and TR was limited to two experienced surgeons. Outcome data before and after this quality improvement process were compared. Non-TR patients from the same time period served as controls. Data are quoted as median (range) and non-parametric tests used to compare. P < 0.05 was regarded as significant. Results There were 23 neonatal TR patients with median follow-up of 3.6 (range 0.4–7) years. Median age at repair was 2 (range 0–21) days. There were 5 patch repairs (22%), all after 2008. There were 9 recurrences (39%) at a median time of 162 days after TR, compared to 13 (10%) recurrences in the control cohort. For primary TR, there was a trend towards a decreased recurrence rate from 50% prior to 2008 to 25% after 2008 (P = 0.26). Conclusions Systematic quality review was modestly effective in decreasing the recurrence rate for neonatal TR, but further outcome data are required.
ISSN:0022-3468
1531-5037
DOI:10.1016/j.jpedsurg.2012.11.012