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A risk-stratified analysis of delayed congenital diaphragmatic hernia repair: does timing of operation matter?
[congenital diaphragmatic hernia]
Congenital
diaphragmatic
hernia
(
CDH
)
remains
a
significant
cause
of
death
in
newborns
and
,
despite
improved
outcomes
with
multimodality
therapies
,
optimal
timing
of
repair
remains
undefined
.
We
sought
to
evaluate
the
influence
of
surgical
timing
on
patient
outcomes
and
hypothesized
that
delayed
repair
does
not
improve
survival
in
CDH
.
Prospectively
collected
data
from
1
,
385
CDH
Registry
infants
without
preoperative
extracorporeal
membrane
oxygen
therapy
(
ECMO
)
were
evaluated
.
Patients
were
stratified
by
timing
of
repair
:
Day
of
life
(
DOL
)
0
-
3
(
group
1
)
,
4
-
7
(
group
2
)
,
or
>
8
(
group
3
)
,
and
the
effect
of
surgical
timing
on
mortality
was
determined
by
logistic
regression
and
risk-adjusted
for
severity
of
illness
.
The
unadjusted
odds
ratio
(
OR
)
for
mortality
increased
significantly
with
delayed
repair
(
group
2
,
1
.
73
[
95
%
CI
,
1
.
00
-
2
.
98
;
group
3
,
3
.
42
[
95
%
CI
,
1
.
97
-
5
.
96
]
)
.
However
,
when
adjusted
for
severity
of
illness
,
delay
in
repair
did
not
predict
increased
mortality
(
group
2
,
1
.
2
[
95
%
CI
,
0
.
7
-
2
.
2
]
;
group
3
,
1
.
4
[
95
%
CI
,
0
.
8
-
2
.
6
]
)
,
nor
did
it
portend
an
increased
need
for
postoperative
ECMO
(
group
2
,
1
.
1
[
95
%
CI
,
0
.
5
-
2
.
4
]
;
group
3
,
0
.
5
[
95
%
CI
,
0
.
2
-
1
.
4
]
)
.
After
adjustment
for
known
risk
factors
,
the
timing
of
CDH
repair
in
low
-risk
infants
does
not
seem
to
influence
mortality
.
However
,
specific
clinical
parameters
guiding
timing
of
elective
CDH
repair
remain
unknown
.
Diseases
Validation
Diseases presenting
"increased need for postoperative ecmo (group"
symptom
congenital diaphragmatic hernia
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