A risk-stratified analysis of delayed congenital diaphragmatic hernia repair: Does timing of operation matter?

• Published in: Surgery 2014-08, Vol.156 (2), p.475-482
• Main Authors: Hollinger, Laura E., MD, Lally, Pamela A., MD, Tsao, KuoJen, MD, Wray, Curtis J., MD, Lally, Kevin P., MD, MS
• Format: Article
• Language: English
• Subjects: Extracorporeal Membrane Oxygenation; Hernia, Diaphragmatic - pathology; Hernia, Diaphragmatic - surgery; Hernia, Diaphragmatic - therapy; Hernias, Diaphragmatic, Congenital; Herniorrhaphy - adverse effects; Herniorrhaphy - methods; Herniorrhaphy - mortality; Humans; Infant Mortality; Infant, Newborn; Prospective Studies; Registries; Risk Factors; Severity of Illness Index; Surgery; Texas - epidemiology; Time Factors; Treatment Outcome
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2014.04.015

Background Congenital diaphragmatic hernia (CDH) remains a significant cause of death in newborns and, despite improved outcomes with multimodality therapies, optimal timing of repair remains undefined. We sought to evaluate the influence of surgical timing on patient outcomes and hypothesized that delayed repair does not improve survival in CDH. Methods Prospectively collected data from 1,385 CDH Registry infants without preoperative extracorporeal membrane oxygen therapy (ECMO) were evaluated. Patients were stratified by timing of repair: Day of life (DOL) 0–3 (group 1), 4–7 (group 2), or >8 (group 3), and the effect of surgical timing on mortality was determined by logistic regression and risk-adjusted for severity of illness. Results The unadjusted odds ratio (OR) for mortality increased significantly with delayed repair (group 2, 1.73 [95% CI, 1.00–2.98; group 3, 3.42 [95% CI, 1.97–5.96]). However, when adjusted for severity of illness, delay in repair did not predict increased mortality (group 2, 1.2 [95% CI, 0.7–2.2]; group 3, 1.4 [95% CI, 0.8–2.6]), nor did it portend an increased need for postoperative ECMO (group 2, 1.1 [95% CI, 0.5–2.4]; group 3, 0.5 [95% CI, 0.2–1.4]). Conclusion After adjustment for known risk factors, the timing of CDH repair in low-risk infants does not seem to influence mortality. However, specific clinical parameters guiding timing of elective CDH repair remain unknown.