Appropriate timing of surgery for neonates with congenital diaphragmatic hernia: early or delayed repair?
OBJECTIVE
This study was aimed to evaluate the influence of timing of surgery on patient outcomes, and to clarify appropriate timing of surgery in neonates with congenital diaphragmatic hernia (CDH).


METHODS
A total of 477 neonates with isolated CDH were included. Patients were classified into two groups by timing of surgery: early repair (ER) (≤48 h) and delayed repair (DR) (>48 h). The primary outcome was 90-day survival, with treatment duration (ventilation, oxygen, and hospitalization) being a secondary outcome. To adjust for disease severity, patients were stratified into three severities by Apgar score 1 min ("mild" 8-10, "moderate" 4-7, and "severe" 0-3), and outcomes were compared between ER and DR within each severity.


RESULTS
Although 90-day survival was significantly different among the three severities ("mild" 97%, "moderate" 89%, and "severe" 76%, p = 0.002), there were no differences in 90-day survival between DR and ER within each severity. In "mild", there were no differences in treatment duration between ER and DR. In "moderate", treatment duration was shorter in ER than DR (ventilation 11 vs. 16 days, oxygen 15 vs. 20 days, and hospitalization 34 vs. 48 days). In "severe", treatment duration was shorter in ER than DR, while the best OI was higher in DR than ER.


CONCLUSIONS
Timing of CDH repair seems to have no influence on 90-day survival regardless of disease severity. Patients with moderate severity may benefit from the early repair by reducing treatment duration.
Department of Pediatric Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan. okuyama@pedsurg.med.osaka-u.ac.jp.
Hiroomi
H
Okuyama
Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
Noriaki
N
Usui
Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan.
Masahiro
M
Hayakawa
Department of Pediatric Surgery, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
Tomoaki
T
Taguchi
D005260:Female; D065630:Hernias, Diaphragmatic, Congenital / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D061646:Operative Time; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D013995:Time; D016896:Treatment Outcome
Congenital diaphragmatic hernia; Neonates; Repair; Timing