医学
先天性膈疝
膈疝
死亡率
出生体重
膈式呼吸
死亡风险
外科
儿科
内科学
疝
怀孕
胎儿
替代医学
病理
生物
遗传学
作者
Vikas Gupta,Matthew T. Harting,Pamela A. Lally,Charles C. Miller,Ronald B. Hirschl,Carl Davis,Melvin S. Dassinger,Terry L. Buchmiller,Krisa P. Van Meurs,Bradley A. Yoder,Michael J. Stewart,Kevin P. Lally
出处
期刊:Annals of Surgery
[Ovid Technologies (Wolters Kluwer)]
日期:2021-07-29
卷期号:277 (3): 520-527
被引量:38
标识
DOI:10.1097/sla.0000000000005113
摘要
Objective: To determine if risk-adjusted survival of patients with CDH has improved over the last 25 years within centers that are long-term, consistent participants in the CDH Study Group (CDHSG). Summary Background Data: The CDHSG is a multicenter collaboration focused on evaluation of infants with CDH. Despite advances in pediatric surgical and intensive care, CDH mortality has appeared to plateau. Herein, we studied CDH mortality rates amongst long-term contributors to the CDHSG. Methods: We divided registry data into 5-year intervals, with Era 1 (E1) beginning in 1995, and analyzed multiple variables (operative strategy, defect size, and mortality) to assess evolution of disease characteristics and severity over time. For mortality analyses, patients were risk stratified using a validated prediction score based on 5-minute Apgar (Apgar5) and birth weight. A risk-adjusted, observed to expected (O:E) mortality model was created using E1 as a reference. Results: 5203 patients from 23 centers with >22years of participation were included. Birth weight, Apgar5, diaphragmatic agenesis, and repair rate were unchanged over time (all P > 0.05). In E5 compared to E1, minimally invasive and patch repair were more prevalent, and timing of diaphragmatic repair was later (all P < 0.01). Overall mortality decreased over time: E1 (30.7%), E2 (30.3%), E3 (28.7%), E4 (26.0%), E5 (25.8%) ( P = 0.03). Risk-adjusted mortality showed a significant improvement in E5 compared to E1 (OR 0.78, 95% CI 0.62-0.98; P = 0.03). O:E mortality improved over time, with the greatest improvement in E5. Conclusions: Risk-adjusted and observed-to-expected CDH mortality have improved over time.
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