Optimal surgical timing for congenital diaphragmatic hernia in a non-ECMO center: a retrospective study

This study aims to address the timing of repair for severe congenital diaphragmatic hernia (CDH) without the use of extracorporeal membrane oxygenation (ECMO) and to determine the feasibility of an earlier intervention to avoid deaths associated with non-repair in patients who are more challenging to stabilize without ECMO.

This single-center retrospective study was conducted on neonates with CDH from 2013 to 2023. Based on the timing of surgery, the patients were classified into three groups: <24 hours (group A), 24-48 hours (group B) and ≥48 hours (group C). The 90-day survival rates were analyzed using Kaplan-Meier curves and compared among groups via log-rank tests. The independent factors related to survival assessed using the multivariate Cox regression model.

Of 132 CDH infants, the overall 90-day survival rate was 81.8% (108/132), with a median operative time of 26.00 (24.00, 38.50) hours. A significant difference was observed in the 90-day survival rate among the three groups: 60.5% (23/38) in group A vs. 91.3% (74/81) in group B vs. 84.6% (11/13) in group C (log-rank p<0.001). In mild and severe cases and those with an oxygen index ≥7.5, group A resulted in significantly reduced survival rates. Multivariate Cox regression analysis indicated that surgical timing <24 hours remained an independent mortality-related risk factor in infants with CDH.

Repair surgery should be performed at least 24 hours after birth. The optimal timing for CDH neonates in non-ECMO centers appears to be 24-48 hours after birth, which can prevent the loss of treatment opportunities for severe cases.