• Annals of surgery · Mar 2023

    Multicenter Study

    Mortality in Congenital Diaphragmatic Hernia: A Multicenter Registry Study of Over 5000 Patients Over 25 Years.

    • Vikas S Gupta, Matthew T Harting, Pamela A Lally, Charles C Miller, Ronald B Hirschl, Carl F Davis, MelvinIII S Dassinger, Terry L Buchmiller, Krisa P Van Meurs, Bradley A Yoder, Michael J Stewart, Kevin P Lally, and Congenital Diaphragmatic Hernia Study Group.
    • Department of Pediatric Surgery, McGovern Medical School at the, University of Texas Health Science Center and Children's Memorial Hermann, Hospital, Houston, Texas.
    • Ann. Surg. 2023 Mar 1; 277 (3): 520527520-527.

    ObjectiveTo determine if risk-adjusted survival of patients with CDH has improved over the last 25 years within centers that are long-term, consistent participants in the CDH Study Group (CDHSG).Summary Background DataThe CDHSG is a multicenter collaboration focused on evaluation of infants with CDH. Despite advances in pediatric surgical and intensive care, CDH mortality has appeared to plateau. Herein, we studied CDH mortality rates amongst long-term contributors to the CDHSG.MethodsWe divided registry data into 5-year intervals, with Era 1 (E1) beginning in 1995, and analyzed multiple variables (operative strategy, defect size, and mortality) to assess evolution of disease characteristics and severity over time. For mortality analyses, patients were risk stratified using a validated prediction score based on 5-minute Apgar (Apgar5) and birth weight. A risk-adjusted, observed to expected (O:E) mortality model was created using E1 as a reference.Results5203 patients from 23 centers with >22years of participation were included. Birth weight, Apgar5, diaphragmatic agenesis, and repair rate were unchanged over time (all P > 0.05). In E5 compared to E1, minimally invasive and patch repair were more prevalent, and timing of diaphragmatic repair was later (all P < 0.01). Overall mortality decreased over time: E1 (30.7%), E2 (30.3%), E3 (28.7%), E4 (26.0%), E5 (25.8%) ( P = 0.03). Risk-adjusted mortality showed a significant improvement in E5 compared to E1 (OR 0.78, 95% CI 0.62-0.98; P = 0.03). O:E mortality improved over time, with the greatest improvement in E5.ConclusionsRisk-adjusted and observed-to-expected CDH mortality have improved over time.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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