title: Long-term surgical outcomes in congenital diaphragmatic hernia: observations from a single institution.
abstract: OBJECTIVE
  Surgical complications are common in survivors of congenital diaphragmatic hernia (CDH), but little is known about long-term incidence patterns and associated predictors.
  
  
  METHODS
  A cohort of 99 CDH survivors was prospectively followed at a single-institution multidisciplinary clinic. Data were gathered regarding the adverse surgical outcomes of hernia recurrence, chest and spinal deformity, and operative small bowel obstruction (SBO), and then were retrospectively analyzed in relation to perinatal and perioperative markers of disease severity to determine significant predictors. Statistical methods used included univariate and multivariate regression analysis, hazard modeling, and Kaplan-Meier analysis.
  
  
  RESULTS
  At a median cohort age of 4.7 (range, 0.2-10.6) years, 46% of patients with patch repairs and 10% of those with primary repairs had a hernia recurrence at a median time of 0.9 (range, 0.1-7.3) years after repair. Chest deformity was detected in 47%. Small bowel obstruction and scoliosis occurred in 13%. Recurrence and chest deformity were significantly more common with patch repair, liver herniation, age at neonatal extubation greater than 16 days, oxygen requirement at discharge, and prematurity. The strongest predictor of SBO was patch repair. Multivariate analysis showed that patch repair was independently predictive of recurrence and early chest deformity (odds ratios of 5.0 and 4.8, confidence intervals of 1-24 and 1-21, P < .05). Use of an absorbable patch was associated with the highest risk of surgical complications.
  
  
  CONCLUSIONS
  For long-term survivors of CDH, specific perinatal and operative variables, particularly patch repair, are associated with subsequent adverse surgical outcomes.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, University of California, San Francisco, CA 94143, USA.
authors.forename: Tim
authors.initials: T
authors.lastname: Jancelewicz
authors.forename: Lan T
authors.initials: LT
authors.lastname: Vu
authors.forename: Roberta L
authors.initials: RL
authors.lastname: Keller
authors.forename: Barbara
authors.initials: B
authors.lastname: Bratton
authors.forename: Hanmin
authors.initials: H
authors.lastname: Lee
authors.forename: Diana
authors.initials: D
authors.lastname: Farmer
authors.forename: Michael
authors.initials: M
authors.lastname: Harrison
authors.forename: Doug
authors.initials: D
authors.lastname: Miniati
authors.forename: Tippi
authors.initials: T
authors.lastname: Mackenzie
authors.forename: Shinjiro
authors.initials: S
authors.lastname: Hirose
authors.forename: Kerilyn
authors.initials: K
authors.lastname: Nobuhara
mesh_terms: D002140:California / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006548:Hernia, Diaphragmatic / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D015994:Incidence; D007223:Infant; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000209:etiology; D008137:Longitudinal Studies; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D013526:Surgical Mesh; D016019:Survival Analysis; D016896:Treatment Outcome