Surg Today

. 2020 Oct 10. doi: 10.1007/s00595-020-02156-7. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/33040204/

Optimal timing of surgery in infants with prenatally diagnosed isolated left-sided congenital diaphragmatic hernia: a multicenter, cohort study in Japan

Masaya Yamoto ¹, Satoko Ohfuji ², Naoto Urushihara ³, Keita Terui ⁴, Kouji Nagata ⁵, Tomoaki Taguchi ⁵, Masahiro Hayakawa ⁶, Shoichiro Amari ⁷, Kouji Masumoto ⁸, Tadaharu Okazaki ⁹, Noboru Inamura ¹⁰, Katsuaki Toyoshima ¹¹, Keiichi Uchida ¹², Taizo Furukawa ¹³, Manabu Okawada ¹⁴, Akiko Yokoi ¹⁵, Yukata Kanamori ¹⁶, Noriaki Usui ¹⁷, Yuko Tazuke ¹⁸, Ryuta Saka ¹⁸, Hiroomi Okuyama ¹⁸, Japanese Congenital Diaphragmatic Hernia Study GroupAffiliations expand

• PMID: 33040204
• DOI: 10.1007/s00595-020-02156-7

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Abstract

Purpose: To date, there is no compelling evidence of the optimal timing of surgery for congenital diaphragmatic hernia (CDH). This study aimed to establish the optimal timing of surgery in neonates with isolated left-sided CDH.

Methods: This multicenter cohort study enrolled 276 patients with isolated left-sided CDH at 15 institutions. Based on the timing of surgery, the patients were classified into four groups [< 24 h (G1), 24-47 h (G2), 48-71 h (G3), and ≥ 72 h (G4)]. The clinical outcomes were compared among the groups using a logistic regression model, after adjusting for potential confounders, such as disease severity.

Results: Multivariate analyses showed that G2 also had a lower mortality rate than the other groups. In mild and severe cases, there were no significant differences in mortality across the four groups. In moderate cases, G2 resulted in significantly increased survival rates, compared with G1.

Conclusion: The study results suggest that surgery within 24 h of birth is not recommended for patients with moderate severity CDH, that there is no benefit in the delay of surgery for more than 72 h in mild severity CDH patients, and that there is no definite optimal time to perform surgery in severe cases of CDH.

Keywords: Cohort study; Congenital diaphragmatic hernia; Gentle ventilation; Multicenter; Timing of surgery.