title: Factors associated with early recurrence after congenital diaphragmatic hernia repair.
abstract: BACKGROUND
  The purpose of this study was to identify patient and treatment characteristics associated with early (in hospital) hernia recurrence after congenital diaphragmatic hernia (CDH) repair.
  
  
  METHODS
  Data from the Congenital Diaphragmatic Hernia Study Group registry were queried from 2007 to 2015. Recurrence of the diaphragmatic hernia after initial repair and prior to death or discharge was determined at the time of reoperation. Minimally invasive surgery (MIS) approaches included laparoscopy or thoracoscopy, and open approaches consisted of laparotomy or thoracotomy. Multivariate regression analysis was performed.
  
  
  RESULTS
  Of 3984 patients, 3332 (84%) underwent CDH repair. 76 (2.3%) patients had an early recurrence. The rate of recurrence was less variable over time for patients undergoing laparotomy vs thoracoscopy (range: 1.1-3.7% vs 1.7-8.9% annually). Timing of repair, whether performed after, during, or before ECMO did not significantly alter recurrence rates (0% vs 4.2% vs 3.0%, p=0.116). Larger defect size (C: OR 4.3, 95% CI 1.2-15.4; D: OR 7.1, 95% CI 1.7-29.1) and an MIS approach (OR 3.2, 95% CI 1.7-6.0) were the only independent predictors of recurrence.
  
  
  CONCLUSIONS
  Larger defect size and an MIS approach were associated with higher rates of early recurrence, while ECMO use and timing of repair with ECMO were not.
  
  
  METHODS
  Treatment study.
  
  
  METHODS
  II.
authors.affiliation: Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, TX, United States; Center for Surgical Trials and Evidence-based Practice (CSTEP), University of Texas Medical School at Houston, Houston, TX, United States.
authors.forename: Luke R
authors.initials: LR
authors.lastname: Putnam
authors.affiliation: Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, TX, United States.
authors.forename: Vikas
authors.initials: V
authors.lastname: Gupta
authors.affiliation: Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, TX, United States; Center for Surgical Trials and Evidence-based Practice (CSTEP), University of Texas Medical School at Houston, Houston, TX, United States.
authors.forename: Kuojen
authors.initials: K
authors.lastname: Tsao
authors.affiliation: Department of Paediatric Surgery, Royal Hospital for Children, Glasgow, Scotland, UK.
authors.forename: Carl F
authors.initials: CF
authors.lastname: Davis
authors.affiliation: Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, TX, United States; Center for Surgical Trials and Evidence-based Practice (CSTEP), University of Texas Medical School at Houston, Houston, TX, United States.
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Lally
authors.affiliation: Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, TX, United States; Center for Surgical Trials and Evidence-based Practice (CSTEP), University of Texas Medical School at Houston, Houston, TX, United States.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Lally
authors.affiliation: Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, TX, United States; Center for Surgical Trials and Evidence-based Practice (CSTEP), University of Texas Medical School at Houston, Houston, TX, United States. Electronic address: matthew.t.harting@uth.tmc.edu.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Harting
mesh_terms: D003131:Combined Modality Therapy; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D065630:Hernias, Diaphragmatic, Congenital / Q000601:surgery* / Q000628:therapy; D059685:Herniorrhaphy / Q000379:methods; D006801:Humans; D007231:Infant, Newborn; D010535:Laparoscopy; D007813:Laparotomy; D008297:Male; D015999:Multivariate Analysis; D012008:Recurrence; D012042:Registries; D012307:Risk Factors; D013906:Thoracoscopy; D013908:Thoracotomy; D016896:Treatment Outcome
keywords: Congenital diaphragmatic hernia; Defect size; Extracorporeal membrane oxygenation; Minimally-invasive surgery; Recurrence