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Surgical Repair of Congenital Diaphragmatic Hernia After Extracorporeal Membrane Oxygenation Cannulation: Early Repair Improves Survival
- Source :
- Annals of surgery. 274(1)
- Publication Year :
- 2019
-
Abstract
- OBJECTIVE To determine the optimal timing of congenital diaphragmatic hernia (CDH) repair after extracorporeal membrane oxygenation (ECMO) cannulation. SUMMARY BACKGROUND DATA The timing of CDH repair after ECMO cannulation remains a controversial topic due to studies with low power or strong selection bias. METHODS This is a 2-aim retrospective cohort study based on the CDH Study Group registry for the period of 2007-2017. Aim 1-Compare On versus After ECMO repair. Aim 2-Compare Early versus Late repair on ECMO. In order to minimize selection bias and account for non-repairs, subjects in each aim were stratified into study groups based on their treatment center's characteristics. In each aim, the study groups were matched based on propensity score (PS). The main outcomes included mortality rate and incidence of non-repair. RESULTS In aim 1, 136 patients remained in each group after PS matching. Compared to the After ECMO group, patients in the On ECMO group demonstrated a lower mortality rate, hazard ratio (HR) 0.54 (0.38, 0.77) (P < 0.001), and lower incidence of non-repair, 5.9% versus 33.8% (P < 0.001). In aim 2, 77 patients remained in each group after PS matching. Compared to the Late group, Early repair of CDH on ECMO was associated with a lower mortality rate, HR 0.51 (0.33, 0.77) (P = 0.002), and lower incidence of non-repair, 9.1% versus 44.2% (P < 0.001). CONCLUSIONS The approach of early repair after ECMO cannulation is associated with improved survival compared to delayed surgical correction.
- Subjects :
- Male
medicine.medical_specialty
medicine.medical_treatment
Diaphragmatic breathing
Time-to-Treatment
03 medical and health sciences
0302 clinical medicine
Extracorporeal Membrane Oxygenation
Extracorporeal membrane oxygenation
medicine
Humans
Propensity Score
Herniorrhaphy
Proportional Hazards Models
Retrospective Studies
Surgical repair
business.industry
Mortality rate
Hazard ratio
Infant, Newborn
Congenital diaphragmatic hernia
Retrospective cohort study
medicine.disease
Survival Analysis
Surgery
surgical procedures, operative
030220 oncology & carcinogenesis
Propensity score matching
030211 gastroenterology & hepatology
Female
business
Hernias, Diaphragmatic, Congenital
Subjects
Details
- ISSN :
- 15281140
- Volume :
- 274
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Annals of surgery
- Accession number :
- edsair.doi.dedup.....ede0f4dbd14914715b75fb6e7a6730c0