title: Prevalence, outcomes, and a risk-benefit analysis of diaphragmatic hernia admissions: an examination of the National Inpatient Sample database.
abstract: OBJECTIVE
  Current practice is to repair uncomplicated diaphragmatic hernias (UDHs) to avoid complications such as obstruction or gangrene. However, practice patterns are based on limited data. We analyzed the National Inpatient Sample to compare outcomes of patients with obstructed (ODH) or gangrenous (GDH) diaphragmatic hernias and those who underwent repair of UDHs to perform a risk-benefit analysis of observation versus elective repair.
  
  
  METHODS
  We queried the National Inpatient Sample for hospitalized patients who underwent a UDH repair as the principal procedure during their admission. To this repair group, we compared the outcomes of those patients who had a diagnosis of GDH or ODH. A risk-benefit analysis of observation versus elective repair was performed based on these data.
  
  
  RESULTS
  Over a 10-year period, 193,554 admissions for the diagnosis of diaphragmatic hernia were identified. A UDH was the diagnosis in 161,777 (83.6%) admissions with 38,764 (24.0%) admissions for elective repair. ODH or GDH was the reason for admission in 31,127 (16.1%) and 651 (0.3%), respectively. Compared with patients who underwent elective repair, mortality was higher in patients with ODH or GDH (1% vs 4.5%; P < .001; and 1% vs 27.5%; P < .001). Risk-benefit analysis suggested a small but real benefit to elective repair in patients aged 50 to 70 years or if the operative mortality is 1% or less.
  
  
  CONCLUSIONS
  Elective UDH repair is associated with better outcomes than admissions for ODH or GDH with a favorable risk-benefit profile than observation if the operative mortality is low.
authors.affiliation: Division of Thoracic Surgery, Department of Public Health, New York Presbyterian Hospital System, New York, NY 10065, USA. pas2022@med.cornell.edu
authors.forename: Subroto
authors.initials: S
authors.lastname: Paul
authors.forename: Farooq M
authors.initials: FM
authors.lastname: Mirza
authors.forename: Abu
authors.initials: A
authors.lastname: Nasar
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Port
authors.forename: Paul C
authors.initials: PC
authors.lastname: Lee
authors.forename: Brendon M
authors.initials: BM
authors.lastname: Stiles
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Nguyen
authors.forename: Art
authors.initials: A
authors.lastname: Sedrakyan
authors.forename: Nasser K
authors.initials: NK
authors.lastname: Altorki
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D019992:Databases as Topic; D017558:Elective Surgical Procedures; D005260:Female; D005734:Gangrene; D006548:Hernia, Diaphragmatic / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data*; D018579:Patient Selection; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology