One-year outcomes of congenital diaphragmatic hernia repair: Factors associated with recurrence and complications*,**
One-year outcomes of congenital diaphragmatic hernia repair: Factors associated with recurrence and complications*,**
复制标题
DOI：
10.1016/j.jpedsurg.2020.09.018
复制
发表时间：
2021-08-19
影响因子：
2.4
通讯作者：
Thorson, Chad M.
中科院分区：
文献类型：
--
作者：
Cioci, Alessia C.;Urrechaga, Eva M.;Thorson, Chad M.
目的：先天性腹股沟疝（CDH）是一种与终身多系统疾病相关的先天性异常。本研究旨在确定导致CDH修复后再入院的因素。方法：使用2010年至2014年的全国再入院数据库来识别接受手术修复的CDH患者。主要结局包括30天和1年时的全因再入院和疝复发再入院。使用卡方分析比较患者和医院因素。结果：501例新生儿CDH患者被确定。所有修复术均在教学医院进行，59%（n = 303）为剖腹手术，36%（n = 183）为开胸手术，5%（n = 25）为微创（MIS）修复。30天内再入院率为32%（n = 163），1年内再入院率为97%（n = 495）。最常见的再入院情况是胃食管反流（20%）、CDH复发（17%）和胃造瘘管和/或胃底折叠术（16%）。MIS修复后的复发率（48%）显著高于经任一入路开放修复的复发率（16%），p < 0.001。结论：这是第一项评估全国范围内新生儿先天性心脏病再入院率的研究。再次入院通常是由于CDH复发和返流相关并发症。复发率高于以前报道的，并且在MIS和经开胸手术修复后更常见。证据等级：III级治疗研究。(c)2020由Elsevier Inc.出版。
Purpose: Congenital diaphragmatic hernia (CDH) is a congenital anomaly associated with lifelong multisystem morbidity. This study sought to identify factors contributing to hospital readmission after CDH repair. Methods: The Nationwide Readmissions Database from 2010 to 2014 was used to identify patients with CDH who underwent surgical repair. Primary outcomes included all cause readmission at 30-days and 1 year and readmission for hernia recurrence. Patient and hospital factors were compared using chi-squared analysis. Results: Five hundred eleven patients were identified with neonatal CDH. All repairs were performed at teaching hospitals via laparotomy in 59% (n = 303), thoracotomy in 36% (n = 183), and minimally invasive (MIS) repair in 5% (n = 25). The readmission rate within 30-days was 32% (n = 163), and 97% (n = 495) within 1 year. The most common conditions surrounding readmission were for gastroesophageal reflux (20%), CDH recurrence (17%), and surgery for gastrostomy tube and/or fundoplication (16%). Recurrence was significantly higher after MIS repair (48%) compared to those with open repair via either approach (16%), p < 0.001. Conclusions: This is the first study to evaluate nationwide readmissions in newborns with CDH. Readmission is commonly due to CDH recurrence and reflux-associated complications. The recurrence rate is higher than previously reported and is more common after MIS and repair via thoracotomy. Level of evidence: Level III treatment study. (c) 2020 Published by Elsevier Inc.