TY - JOUR
T1 - Congenital diaphragmatic hernia (CDH) mortality without surgical repair? A plea to clarify surgical ineligibility
AU - Wilson, Marnie Goodwin
AU - Beres, Alana
AU - Baird, Robert
AU - Laberge, Jean Martin
AU - Skarsgard, Erik D.
AU - Puligandla, Pramod S.
PY - 2013/5
Y1 - 2013/5
N2 - AbstractPurpose Little is known about liveborn CDH patients who die without surgery. We audited a national CDH cohort to determine whether these patients were different from patients who received CDH repair. Methods A national CDH database was analyzed (2005-2009). After excluding infants with severe physiologic instability and genetic/congenital malformations, a potential surgical candidate (PSC) subgroup was identified. PSCs were compared to the operative group (OG) and the operative non-survivor (ONS) subgroup. Standard statistical analyses were performed. Results Of 275 liveborns, 35 (13%) died without surgery. The PSC subgroup (n = 11) had a median survival of 10 days (range: 3-18). Ten of 11 PSC infants were treated in ECMO centers, with 4 receiving ECMO. No differences in BW, GA, and rates of minor malformation were observed between PSC and OG patients. While neonatal illness severity (SNAP-II) predicted overall mortality, SNAP-II scores were similar between PSC and ONS groups (34 vs. 29; p = 0.431). Furthermore, greater than 80% of infants with SNAP-II scores between 30 and 39 survived in the OG cohort. Conclusion Our analysis demonstrated that PSCs were similar to infants offered surgery based on illness severity and the presence of congenital malformations. We suggest that criteria for surgical ineligibility be developed to standardize the selection of surgical candidates.
AB - AbstractPurpose Little is known about liveborn CDH patients who die without surgery. We audited a national CDH cohort to determine whether these patients were different from patients who received CDH repair. Methods A national CDH database was analyzed (2005-2009). After excluding infants with severe physiologic instability and genetic/congenital malformations, a potential surgical candidate (PSC) subgroup was identified. PSCs were compared to the operative group (OG) and the operative non-survivor (ONS) subgroup. Standard statistical analyses were performed. Results Of 275 liveborns, 35 (13%) died without surgery. The PSC subgroup (n = 11) had a median survival of 10 days (range: 3-18). Ten of 11 PSC infants were treated in ECMO centers, with 4 receiving ECMO. No differences in BW, GA, and rates of minor malformation were observed between PSC and OG patients. While neonatal illness severity (SNAP-II) predicted overall mortality, SNAP-II scores were similar between PSC and ONS groups (34 vs. 29; p = 0.431). Furthermore, greater than 80% of infants with SNAP-II scores between 30 and 39 survived in the OG cohort. Conclusion Our analysis demonstrated that PSCs were similar to infants offered surgery based on illness severity and the presence of congenital malformations. We suggest that criteria for surgical ineligibility be developed to standardize the selection of surgical candidates.
KW - CAPSNet
KW - Congenital diaphragmatic hernia
KW - Mortality outcomes
KW - Surgical ineligibility
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U2 - 10.1016/j.jpedsurg.2013.02.009
DO - 10.1016/j.jpedsurg.2013.02.009
M3 - Article
C2 - 23701761
AN - SCOPUS:84878000867
SN - 0022-3468
VL - 48
SP - 924
EP - 929
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
IS - 5
ER -