title: Comparative analysis of diaphragmatic hernia repair outcomes using the nationwide inpatient sample database.
abstract: OBJECTIVE
  To determine the comparative effectiveness of various approaches to diaphragmatic hernia (DH) repair, including open abdominal, laparoscopic abdominal, and thoracotomy.
  
  
  METHODS
  Using the Nationwide Inpatient Sample from 1999 to 2008, a comprehensive cohort of 38 764 patients (mean [SD] age, 60.8 [19.5] years) hospitalized with a primary diagnosis of DH who underwent repair was identified.
  
  
  METHODS
  Morbidity and mortality of patients who underwent DH repair.
  
  
  RESULTS
  Open approaches were the most common, performed in 91% of patients (open abdominal, n=28 824 [74.4%]; thoracotomy, n=6573 [17.0%]). Hospital mortality was 1.1% or less for each of the approaches. However, patients who underwent a laparoscopic DH repair had a shorter length of stay (mean [SD], 4.5 [0.10] days) and fewer discharges to skilled nursing facilities than those who underwent open abdominal or thoracotomy repair approaches. Patients who underwent a DH repair through a thoracotomy approach had the longest length of stay (mean [SD], 7.8 [0.11] days) and a higher need for postoperative mechanical ventilation than those undergoing open or laparoscopic abdominal approaches (5.6% vs 3.2% vs 2.3%, respectively; P.001). In addition, the thoracotomy approach was found to be an independent predictor for the development of a pulmonary embolism.
  
  
  CONCLUSIONS
  This large national study demonstrates that most DH repairs are performed through open abdominal and thoracic approaches. Laparoscopic approaches are associated with decreased length of stay and more routine discharges than open abdominal and thoracotomy approaches.
authors.affiliation: Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York Presbyterian Hospital-Weill Cornell Medical College, NY 10065, USA. pas2022@med.cornell.edu
authors.forename: Subroto
authors.initials: S
authors.lastname: Paul
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 C
authors.initials: BC
authors.lastname: Stiles
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Nguyen
authors.forename: Nasser K
authors.initials: NK
authors.lastname: Altorki
authors.forename: Art
authors.initials: A
authors.lastname: Sedrakyan
mesh_terms: D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D006548:Hernia, Diaphragmatic / Q000401:mortality / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods* / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D012042:Registries; D013908:Thoracotomy; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology