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


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2020-10-10

AUTHORS

Masaya Yamoto, Satoko Ohfuji, Naoto Urushihara, Keita Terui, Kouji Nagata, Tomoaki Taguchi, Masahiro Hayakawa, Shoichiro Amari, Kouji Masumoto, Tadaharu Okazaki, Noboru Inamura, Katsuaki Toyoshima, Keiichi Uchida, Taizo Furukawa, Manabu Okawada, Akiko Yokoi, Yukata Kanamori, Noriaki Usui, Yuko Tazuke, Ryuta Saka, Hiroomi Okuyama

ABSTRACT

PurposeTo 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.MethodsThis 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.ResultsMultivariate 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.ConclusionThe 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. More... »

PAGES

880-890

Journal

TITLE

Surgery Today

ISSUE

6

VOLUME

51

Author Affiliations

  • Department of Pediatric Surgery, Shizuoka Children’s Hospital, 860 Urushiyama, Aoi-ku, 420-8660, Shizuoka, Japan
  • Department of Public Health, Osaka City University Graduate School of Medicine, Osaka, Japan
  • Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
  • Department of Pediatric Surgery, Faculty of Medicine Graduate School of Medical Sciences School of Medicine, Kyushu University, Fukuoka, Japan
  • Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
  • Department of Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
  • Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
  • Department of Pediatric Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
  • Department of Pediatrics, Faculty of Medicine Hospital, Kindai University, Osaka-Sayama, Japan
  • Departments of Neonatology, Kanagawa Childrens Medical Center, Yokohama, Japan
  • Second Department of Surgery, Mie University Graduate School of Medicine, Tsu, Japan
  • Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
  • Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
  • Department of Pediatric Surgery, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
  • Division of Surgery, National Center for Child Health and Development, Tokyo, Japan
  • Department of Pediatric Surgery, Osaka Women’s and Children’s Hospital, Izumi, Japan
  • Department of Pediatric Surgery, Osaka University School of Medicine Graduate School of Medicine, Osaka, Japan
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s00595-020-02156-7

    DOI

    http://dx.doi.org/10.1007/s00595-020-02156-7

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1131597653

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/33040204


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        "description": "PurposeTo 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.MethodsThis 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 [<\u200924\u00a0h (G1), 24\u201347\u00a0h (G2), 48\u201371\u00a0h (G3), and\u2009\u2265\u200972\u00a0h (G4)]. The clinical outcomes were compared among the groups using a logistic regression model, after adjusting for potential confounders, such as disease severity.ResultsMultivariate 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.ConclusionThe study results suggest that surgery within 24\u00a0h 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\u00a0h in mild severity CDH patients, and that there is no definite optimal time to perform surgery in severe cases of CDH.", 
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