Multivariate model for predicting recurrence in congenital diaphragmatic hernia

• Published in: Journal of pediatric surgery 2009-06, Vol.44 (6), p.1173-1180
• Main Authors: Fisher, Jason C, Haley, Mary Jo, Ruiz-Elizalde, Alejandro, Stolar, Charles J.H, Arkovitz, Marc S
• Format: Article
• Language: English
• Subjects: Congenital diaphragmatic hernia; Forecasting; Hernia, Diaphragmatic - surgery; Hernias, Diaphragmatic, Congenital; Humans; Infant, Newborn; Multivariate; Multivariate Analysis; Neonatal; Pediatric; Pediatrics; Recurrence; Surgery
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2009.02.043

Abstract Purpose Risk factors that predispose children with congenital diaphragmatic hernia (CDH) to recurrence remain poorly defined. We report a large series of recurrent CDH and ask whether prenatal patient factors or postnatal treatment variables better predict recurrence. Methods Two hundred thirty-eight neonates with unilateral CDH underwent repair from 1990 to 2006. Data were assessed by χ2 and Mann-Whitney U tests. Multivariate regression identified independent predictors of recurrence. Statistical significance was set at P < .05. Results We identified 24 recurrences (10%). Median time from repair to recurrence diagnosis was 4.9 months. Patients with recurrence were older ( P = .02) and more often required abdominal wall patches at initial repair ( P = .01) compared to nonrecurrence patients. Postoperative length of stay (LOS) after initial repair ( P < .01) and morbidity ( P = .01) were greater in recurrence patients. Use of diaphragm patch at initial repair was greater in patients with recurrence but only approached statistical significance ( P = .05). Only 2 variables independently predicted recurrence by multivariate regression as follows: abdominal (not diaphragm) wall patch during initial repair (odds ratio [OR] 3.50; P = .04) and postoperative LOS (OR, 1.012; P = .01). Conclusion Neonates at risk for CDH recurrence are better identified by postnatal treatment variables than by prenatal patient factors. Although age at repair and diaphragm patch use are greater in recurrence patients, the only factors to independently predict recurrence were postoperative LOS and abdominal wall patch use. These data can help optimize follow-up regimens.