11 - Optimal Timing of Surgery for Congenital Diaphragmatic Hernia, Associated Comorbidities, Complications, and Resource Utilization

Poster Number: 11
Publication Number: 11.337

Ruby Gupta, Medical College of Wisconsin, Milwaukee, WI, United States; Erwin T. Cabacungan, Medical College of Wisconsin, Wauwatosa, Wisconsin/53202, WI, United States

Background: The optimal timing of surgery for congenital diaphragmatic hernia (CDH) remains controversial and it varies across institutions. Surgery is usually done after preoperative cardiopulmonary stabilization. We hypothesize that surgical timing of CDH affects comorbidities, complications, and resource utilization.

Objective: To determine the effect of timing of surgery on infants with CDH on comorbidities, complications, and resource utilization.

Design/Methods: A retrospective cohort study was conducted on hospital discharge data for infants with CDH using the 2016-2019 Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS). We identified patients by ICD-10 codes and used weighted analyses to produce nationally representative estimates. Demographic characteristics, comorbidities, total charges (TCH) and length of stay (LOS) were compared between timing of surgery for CDH < 5 days (d) vs ≥5 d. We used the Cochran-Armitage test for yearly trends, generalized linear model Poisson for LOS and g distribution for TCH. We calculated Odds ratios (OR) to compare outcomes between the two groups, and adjusted for relevant covariates-demographic, hospital characteristics, comorbidities, and complications.

Results: The prevalence of CDH has been steady, with an average of 4.24 per 10,000 live births between 2016-2019 (Fig: 1). Timing of surgery for CDH < 5 d has increased by 29% and surgery ≥5 d has decreased by 22%. Extremely low birth weight [ELBW ( < 1.0 Kgs)] and critical congenital heart anomalies had surgery ≥5 d (p-value 0.03) (Table: 1). Significantly higher number of Infants in large hospital bed size, and Northeast hospital region had surgery on ≥5 d. Later surgery was associated with higher bronchopulmonary dysplasia (BPD), mechanical ventilation, pulmonary hypertension, sepsis, tracheostomy, gastroesophageal reflux disease (GERD), longer LOS, and TCH (Table: 2). The association remained significant for LOS and TCH after adjusting for covariates.Conclusion(s): In this large US database research, we found the timing of surgery for CDH has regional differences, and differences in comorbidities, complications, and resource utilization. This study suggests that goal for timing of surgery for CDH should be < 5 days as soon as cardiopulmonary stabilization is established. We speculate that human factors such as not having national consensus guidelines for surgery readiness may play a role in surgical delay. Future research is needed to evaluate human factors causing delay in surgery and developing standard guidelines for surgery with all types and severity of CDH.
Fig:1 Prevalence of CHD and Timing of Surgery 2016- 2019The average prevalence of CDH has been 4.24 per 10,000 live births. Timing of surgery at < 5 d has increased by 29% and at ≥5 d has decreased by 22%.
Table: 1 Demographics and Hospital Characteristics associated with Surgery for CDH < 5days vs ≥5 daysSurgery at ≥5 days was associated with ELBW ( < 1.0 Kgs), critical congenital heart anomalies, large hospital bed size, and Northeast hospital region.