Impact of prematurity and gestational age at surgery on diaphragmatic plication outcomes.

PURPOSE: Large studies describing outcomes for surgical plication for diaphragmatic eventration (DE) are lacking, and optimal timing of surgery for symptomatic patients is not known. We aimed to assess outcomes of pediatric diaphragmatic plication in a large cohort and assess the impact of prematurity and gestational age at surgery (GAS).

METHODS

The NSQIP pediatric file was queried for diaphragmatic plication (2016-2022). Outcomes included major complications, mortality, hospital stay, and ventilator days. ANOVA and Chi square tests compared outcomes by GAS, with multivariable regression assessing independent effects of GAS and prematurity.

RESULTS

252 children underwent plication; 18 % were premature, 27 % had a GAS under 44 weeks, and 26 % between 44 and 60 weeks. Prematurity was associated with major complications (41 % vs 19 % p < 0.0001), post-operative ventilation (40 % vs 20 % p < 0.001), prolonged ventilator days, and oxygen use at discharge (40 % vs 18 % p < 0.001). Early GAS was significantly associated with major complications (39 % < 44 weeks, 31 % 44-60 weeks, 2 % 60-90 weeks, 10 % 90-200 weeks, 14 % > 200 weeks) and prolonged hospitalization. Multivariable adjustment for ASA class and operative approach demonstrated early GAS and prematurity independently predicted major complications and increased hospital days, with GAS being a stronger predictor for both.

CONCLUSIONS

Complications after diaphragmatic plication in infants are common, particularly those with a history of prematurity. Early GAS is a strong predictor of post-operative morbidity and extended hospital stay and should be considered in timing surgical intervention.