American Surgical Association Home American Surgical Association Annual Meeting
Search Meeting Site Only
Annual Meeting Home
Program
Past & Future Meetings

 

 

Back to Annual Meeting Abstracts


Long Term Maturation of Congenital Diaphragmatic Hernia Treatment Results
David W Kays*, Saleem Islam*, Joy Perkins*, Shawn Larson*, James L. Talbert
University of Florida, Gainesville, FL

Objective: To define the evolution of long-term CDH treatment results.
Background: CDH is a common and potentially lethal birth defect usually diagnosed prenatally. Pregnancy termination rates are significant due to concern about mortality and poor outcomes.
Methods: We analyzed 263 consecutive CDH patients treated at our institution, 60 patients previously reported here compared to 203 since. Our treatment practices focus on gentle ventilator support, with ECMO only as needed. All patients were included in the initial analysis, and patients with lethal associated anomalies were later excluded. Patients with significant but non-lethal associated anomalies, (TOF, coarctation, ASD, VSD, congenital infections, prematurity, and non-lethal chromosomal anomalies) remained. Univariate and multivariate logistic regression was performed.
Results: 208 of 263 consecutive unselected patients with CDH survived to discharge (79%). 26 patients with severe and/or lethal associated anomalies were then excluded. 208 of 237 survived (88%), including 87% of 195 left CDH and 90% of 42 right CDH. 40% of patients required ECMO, and 76% survived. Apgars at 1 and 5 minutes, liver position and liver size in chest were all independently associated with survival and ECMO (p<0.05). 98 of 99 patients with left CDH and liver down survived. 96 of 195 left CDH had liver up (49%) and 75% survived. Subsequent patients showed significantly worse anatomic severity (liver) compared to the initial series, but without change in survival or ECMO.
Conclusions: This is one of the largest single institution CDH series ever reported. Survival rates are highly notable and are maintained despite worsening severity.


Back to Annual Meeting Abstracts

 



© 2019 American Surgical Association. All Rights Reserved. Privacy Policy.