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Congenital Diaphragmatic Hernia: Demographics and 30-day Outcomes in Adults
Joseph G Brungardt1, Quinn A Nix1, Kurt P Schropp1
1Department of Surgery, 21638The University of Kansas, Kansas City, KS, USA.
Insights
Adults undergoing congenital diaphragmatic hernia (CDH) repair show similar outcomes regardless of open or minimally invasive surgery (MIS). Open repair led to a longer hospital stay, while MIS utilized mesh more frequently. Both approaches demonstrated comparable complication rates.
Area of Science:
- Surgical Outcomes
- Hernia Repair
- Adult Congenital Diaphragmatic Hernia
Background:
- Congenital diaphragmatic hernia (CDH) primarily affects pediatric patients, but adult cases also occur.
- Limited research exists on the surgical correction and outcomes for adult CDH patients.
- Adult CDH demographics and surgical outcomes require further investigation.
Purpose of the Study:
- To determine the demographics and outcomes of adult patients undergoing surgical repair of congenital diaphragmatic hernia (CDH).
- To compare outcomes between open and minimally invasive surgery (MIS) approaches for adult CDH repair.
- To identify complication rates and length of stay associated with different surgical methods for adult CDH.
Main Methods:
- Analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database from 2015-2018.
- Inclusion of patients with a postoperative diagnosis of CDH, distinct from ventral hernias.
- Stratification of patients into open or minimally invasive surgery (MIS) groups for comparative analysis.
Main Results:
- 110 adult patients undergoing CDH repair were identified.
- No significant differences in return to operating room, postoperative respiratory failure, or reintubation rates between open and MIS groups.
- Open repair was associated with a longer length of hospital stay (6.47 days) compared to MIS (3.68 days).
- Mesh utilization was significantly higher in the MIS group (47.30%) versus the open group (5.56%).
- No in-hospital mortality was observed, with comparable postoperative complication rates between groups.
Conclusions:
- Surgical repair of adult congenital diaphragmatic hernia (CDH) yields equivalent postoperative outcomes between open and minimally invasive surgery (MIS) approaches.
- Minimally invasive surgery (MIS) may be associated with a shorter length of hospital stay for CDH repair.
- Further research, including case series and retrospective studies, is warranted to fully characterize adult CDH patient outcomes.
Background:
Congenital diaphragmatic hernia (CDH) is a pathology most often affecting the pediatric population, although adults can also be affected. Few studies exist of adults undergoing repair of this defect. Using a national database, we sought to determine demographics and outcomes of this population.
Methods:
An analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database (2015-2018) was performed, capturing patients with postoperative diagnosis of CDH, distinct from ventral hernia. Two groups were created based upon surgical approach of open or minimally invasive (MIS) repair. Baseline demographics and outcomes were compared.
Results:
110 patients undergoing surgical correction of CDH were captured in the database. We found rates of return to the operating room (4.55%), postoperative respiratory failure (5.45%), and reintubation (3.64%) with no difference between groups. There was no mortality and no difference between groups in length of operation, discharge to home, or postoperative complications. Patients undergoing open repair had a longer length of stay than patients in the MIS group (6.47 ± 10.76 days vs. 3.68 ± 3.74 days, P = .0471). Mesh was used in MIS more often than the open group (47.30% vs. 5.56%, P < .0001).
Discussion:
This study describes rates of postoperative complications in patients undergoing repair of CDH, and suggests outcomes those are equivalent between patients receiving open or MIS approaches. Further case series or retrospective studies are needed to further describe this population of patients.
