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Войти в исследования Journal of pediatric surgery · 2026
Impact of hernia sac in congenital diaphragmatic hernia: Associations with morbidity and mortality.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Sutyak Krysta M, Holden Kylie I, Green Charles, Harting Matthew T, Tsao KuoJen, Nagata Kouji, Keijzer Richard, Jank Marietta, Jancelewicz Tim, Church Joseph T, Lally Pamela A, Lally Kevin P, For, The Congenital Diaphragmatic Hernia Study Group
Аннотация
INTRODUCTION: The impact of hernia sac (HS+) on outcomes in congenital diaphragmatic hernia (CDH) when accounting for defect size is unknown. In a multicenter analysis, considering defect size, we aim to delineate the association of HS+ and morbidity and mortality.
METHODS: A retrospective analysis of CDH Study Group (2007-2024) data was performed. Demographics, defect characteristics, morbidity, and mortality were abstracted. Multilevel regression and parallel Bayesian analysis were performed on 80 % of the data, tested on 20 % hold-out data, and reported in area under the curve (AUC).
RESULTS: 7828 operative CDH patients were included. HS+ in 20 %; most common in A and B defects (24 %, 25 %), decreasing in C and D defects (17 %, 7 %); present in a greater proportion of right-sided defects (30 % vs 18 %, p < 0.001). On multilevel logistic regression, with random effects for center, controlling for birth weight, major cardiac abnormalities, chromosomal anomaly, utilization of ECLS, side of the defect, CDHSG A-D, HS+ was not associated with survival (OR 1.19, 95 % CI 0.92-1.53). On Bayesian analysis the OR of HS+ on survival was 1.07 (95 % credible interval 0.87-1.36). HS+ was not associated with pulmonary hypertension (OR 0.97, 95 % CI 0.82-1.14) or cardiac dysfunction at birth. HS+ was associated with a reduction in ECLS utilization (OR 0.60, 95 % CI 0.48-0.74), oxygen status at 30 days (OR 0.56, 95 % CI 0.44-0.70), length of mechanical ventilation (IRR 0.84, 95 % CI 0.79-0.89), and length of hospital stay (IRR 0.92, 95 % CI 0.88-0.96).
CONCLUSION: HS+ is not associated with increased survival, with a neutral Bayesian probability of benefit. However, morbidity outcomes were improved in HS+ patients.
METHODS: A retrospective analysis of CDH Study Group (2007-2024) data was performed. Demographics, defect characteristics, morbidity, and mortality were abstracted. Multilevel regression and parallel Bayesian analysis were performed on 80 % of the data, tested on 20 % hold-out data, and reported in area under the curve (AUC).
RESULTS: 7828 operative CDH patients were included. HS+ in 20 %; most common in A and B defects (24 %, 25 %), decreasing in C and D defects (17 %, 7 %); present in a greater proportion of right-sided defects (30 % vs 18 %, p < 0.001). On multilevel logistic regression, with random effects for center, controlling for birth weight, major cardiac abnormalities, chromosomal anomaly, utilization of ECLS, side of the defect, CDHSG A-D, HS+ was not associated with survival (OR 1.19, 95 % CI 0.92-1.53). On Bayesian analysis the OR of HS+ on survival was 1.07 (95 % credible interval 0.87-1.36). HS+ was not associated with pulmonary hypertension (OR 0.97, 95 % CI 0.82-1.14) or cardiac dysfunction at birth. HS+ was associated with a reduction in ECLS utilization (OR 0.60, 95 % CI 0.48-0.74), oxygen status at 30 days (OR 0.56, 95 % CI 0.44-0.70), length of mechanical ventilation (IRR 0.84, 95 % CI 0.79-0.89), and length of hospital stay (IRR 0.92, 95 % CI 0.88-0.96).
CONCLUSION: HS+ is not associated with increased survival, with a neutral Bayesian probability of benefit. However, morbidity outcomes were improved in HS+ patients.