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Surgical Complications in Children with CDH: A Multivariate Analysis.
Kim Heiwegen1, Iris A L M van Rooij2, Arno van Heijst3
1Department of Pediatric Surgery, Radboudumc-Amalia Children's Hospital, Route 618, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. Kim.Heiwegen@radboudumc.nl.
World Journal of Surgery
|February 2, 2020
Summary
Extracorporeal membrane oxygenation (ECMO) and inhaled nitric oxide increase hemorrhage risk in congenital diaphragmatic hernia (CDH) patients. Abdominal patch repair and pulmonary hypertension are linked to higher CDH recurrence rates.
Area of Science:
- Pediatric Surgery
- Neonatal Medicine
- Critical Care
Background:
- Congenital diaphragmatic hernia (CDH) treatments have improved survival rates but increased morbidity.
- Understanding treatment-specific complications is crucial for optimizing patient outcomes.
Purpose of the Study:
- To evaluate the impact of various medical and surgical interventions on the incidence of surgical complications in CDH patients.
- To identify specific treatments associated with increased morbidity in CDH management.
Main Methods:
- Retrospective analysis of 197 surgically repaired CDH patients (2000-2015).
- Multivariate logistic regression to assess the independent effect of treatments on surgical outcomes.
- Adjustment for multiple risk factors to isolate treatment-specific complications.
Main Results:
- Sixty of 197 CDH patients experienced surgical complications.
- Hemorrhagic complications were significantly higher in the ECMO group (27% vs. 2%, p<0.001).
- Inhaled nitric oxide use was strongly associated with hemorrhage (OR=13.0). Chylothorax was not significantly linked to ECMO or patch repair. Recurrence was associated with pulmonary hypertension (OR=10.0) and abdominal patch use (OR=11.3).
Conclusions:
- ECMO and inhaled nitric oxide, while used for severe CDH, elevate the risk of surgical hemorrhage.
- Abdominal patch repair and pulmonary hypertension are independent risk factors for CDH recurrence.
- Further research should focus on mitigating these treatment-associated risks to improve long-term CDH patient outcomes.
