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Recurrence in congenital diaphragmatic hernia: A multicenter, postdischarge pilot study
Vikas S Gupta1, Kylie I Holden1, Priscilla P Chiu2
1Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center and Children's Memorial Hermann Hospital, Houston, TX.
Insights
Congenital diaphragmatic hernia recurrence occurred in 12% of infants, with higher rates linked to high-risk factors like extracorporeal life support and minimally invasive repair. Defect size also impacts recurrence timing and rates over five years.
Area of Science:
- Pediatric Surgery
- Neonatal Outcomes
- Hernia Research
Background:
- Limited multicenter data existed on postdischarge outcomes for congenital diaphragmatic hernia (CDH).
- Previous studies identified factors for early CDH recurrence.
- This study addresses the gap in understanding long-term recurrence rates.
Purpose of the Study:
- To assess congenital diaphragmatic hernia recurrence rates within the first five years of life.
- To analyze postdischarge outcomes in a multicenter cohort.
- To identify factors influencing CDH recurrence after initial management.
Main Methods:
- Retrospective data collection from four centers (2010-2021).
- Inclusion of infants with CDH managed in outpatient settings.
- Primary outcome: CDH recurrence requiring surgical correction, with follow-up at discharge, 2, and 5 years.
Main Results:
- Overall recurrence rate was 12% (35/297 patients) with long-term follow-up.
- Higher recurrence in high-risk (17%) vs. low-risk (8%) patients.
- Extracorporeal life support (23%) and minimally invasive surgery (35%) were associated with increased recurrence compared to open repair (7%).
Conclusions:
- Congenital diaphragmatic hernia recurrence is influenced by defect size, extracorporeal life support, and surgical approach.
- Smaller defects may recur earlier; larger defects show steady recurrence over five years.
- Findings are crucial for guiding patient counseling and follow-up strategies.
Background:
The Congenital Diaphragmatic Hernia Study Group has previously identified factors associated with early hernia recurrence, but multicenter data on postdischarge outcomes were lacking. The purpose of this study is to assess diaphragmatic hernia recurrence rates in the first 5 years of life using a multicenter cohort.
Methods:
A database was established with data from 4 centers collected retrospectively at perinatal, discharge, 2 years, and 5 years. The study included patients with congenital diaphragmatic hernia managed in the outpatient setting between 2010 and 2021. The primary outcome was recurrence of congenital diaphragmatic hernia requiring operative correction.
Results:
Of the 472 infants with congenital diaphragmatic hernia identified, 297 (81%) had long-term follow-up data: 241 patients were followed up at 2 years and 113 at 5 years. Recurrence occurred in 35 (12%) patients, with higher rates in high-risk (17%) versus low-risk (8%) patients. Extracorporeal life support was associated with increased recurrence (23% vs 10%, predicted to be 32.0% vs 5.8%), and minimally invasive surgery repair had a higher recurrence rate (35% vs 7% for open repair, predicted to be 26.0% vs 6.3%). No difference in recurrence rates was found between patch and primary repair. The model predicted 5-year recurrence rates, higher than the observed rates, of 11.6%, 9.5%, 27.3%, and 33.0% for Congenital Diaphragmatic Hernia Study Group A-D stages, respectively.
Conclusion:
Congenital diaphragmatic hernia defect size, extracorporeal life support, and minimally invasive surgery repair were associated with postdischarge recurrence. Smaller defects tend to recur earlier, whereas larger defects have a steady recurrence rate over 5 years. These findings should guide patient counseling and follow-up planning.
