Multivariate model for predicting recurrence in congenital diaphragmatic hernia
Multivariate model for predicting recurrence in congenital diaphragmatic hernia
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DOI：
10.1016/j.jpedsurg.2009.02.043
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发表时间：
2009-06-01
影响因子：
2.4
通讯作者：
Arkovitz, Marc S.
中科院分区：
文献类型：
--
作者：
Fisher, Jason C.;Haley, Mary Jo;Arkovitz, Marc S.
目的：先天性腹股沟疝（CDH）患儿复发的危险因素尚不明确。我们报告了一个大系列的复发CDH，并询问是否产前患者因素或产后治疗变量更好地预测recombination.Methods：238例单侧CDH新生儿从1990年至2006年进行修复。通过卡方检验和Mann-Whitney U检验评估数据。多元回归分析确定了复发的独立预测因素。统计学显著性设为P <0.05。结果：我们确定了24例复发（10%）。从修复到复发诊断的中位时间为4.9个月。与未复发患者相比，复发患者年龄较大（P = 0.02），初次修复时更常需要腹壁补片（P = 0.01）。复发患者初次修复后的术后住院时间（LOS）（P <0.01）和发病率（P = 0.01）更高。复发患者初次修复时使用隔膜补片的比例更高，但仅接近统计学显著性（P = .05）。通过多元回归，只有2个变量独立预测复发，具体如下：初始修复期间的腹壁（非横隔膜）补片（优势比[OR] 3.50; P = .04）和术后LOS（OR，1.012; P = .01）。结论：通过产后治疗变量比产前患者因素更能识别新生儿CDH复发的风险。虽然复发患者修补时的年龄和隔膜补片的使用更大，但唯一独立预测复发的因素是术后LOS和腹壁补片的使用。这些数据可以帮助优化后续方案。(C)2009爱思唯尔公司All rights reserved.
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 chi(2) 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. (C) 2009 Elsevier Inc. All rights reserved.