Analysis of risk factors of long-term complications in congenital diaphragmatic hernia: A single institution's experience
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Published on: February 5, 2021
Hajime Takayasu1, Kouji Masumoto1, Takahiro Jimbo1
1Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
Insights
Gentle ventilation (GV) improved survival rates for congenital diaphragmatic hernia (CDH) patients. However, preventing short-term complications is crucial to reduce long-term morbidities in CDH survivors.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Critical Care Medicine
Background:
- Congenital diaphragmatic hernia (CDH) is a serious condition requiring specialized management.
- Improving outcomes for CDH survivors remains a key challenge in pediatric surgery.
Purpose of the Study:
- To evaluate the impact of gentle ventilation (GV) on survival and long-term morbidities in congenital diaphragmatic hernia (CDH) patients.
- To identify factors associated with long-term complications in CDH survivors.
Main Methods:
- Retrospective review of 49 CDH patients treated between 1991 and 2011.
- Comparison of outcomes between patients treated before (non-GV group) and after (GV group) the implementation of GV.
Main Results:
- The GV group showed a significantly higher survival rate (95%) compared to the non-GV group (62.1%).
- Despite improved survival, long-term complications remained high in the GV group (73.7%).
- Perioperative complications were significantly associated with the development of long-term complications in the GV group.
Conclusions:
- Gentle ventilation (GV) is effective in improving survival rates for congenital diaphragmatic hernia (CDH) patients.
- Preventing short-term complications is critical for minimizing long-term morbidities in CDH survivors.
Objective:
To establish better management practices to reduce morbidities in survivors with congenital diaphragmatic hernia (CDH).
Methods:
Of 60 patients treated for CDH at our institution between 1991 and 2011, 49 patients without severe anomalies were retrospectively reviewed.
Results:
Since 2004, gentle ventilation (GV) has been the main treatment for CDH. Patients were divided into the following two groups: the non-GV group (n = 29) who were treated before GV treatment was implemented, and the GV group (n = 20). The overall survival rate was 62.1% (18/29) and 95% (19/20) in the non-GV and GV groups, respectively (p = 0.016). Despite the high survival rate, the incidence of long-term complications in survivors was still high (14/19, 73.7%) in the GV group. In the GV group, liver-up (p = 0.106) and the need for patch repair (p = 0.257) tended to be associated with the development of long-term complications, but did not reach statistical significance. The presence of perioperative complications was associated with the development of long-term complications (p = 0.045) in the GV group.
Conclusion:
Patients who developed short-term complications seemed to be at risk of long-term complications. Therefore, to minimize long-term morbidities in CDH survivors, the prevention of short-term complications might be important.
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