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

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

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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.

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