OBJECTIVE To determine practice variation in surgical management of co-morbidities in pediatric patients with Congenital Diaphragmatic Hernia (CDH). BACKGROUND A higher percentage of CDH patients are surviving to discharge, accompanied by an increase in morbidity requiring surgical interventions such as tracheostomy and gastrostomy tube insertion. The frequency, trends, and regional variations in operative management of these co-morbidities in this population are unclear. METHODS Neonates who underwent CDH repair between 2012-2022 in the United States Pediatric Health Information System database were identified. Multivariable regression identified predictive factors for additional surgical morbidity after CDH repair, defined by an additional surgical intervention during index hospitalization or within one year after discharge. To narrow the spectrum of severity of disease, only patients with an intensive care unit admission on index hospitalization were included. Secondary analysis compared frequency of operations and hospital resource utilization by region. RESULTS 4003 patients underwent CDH repair and were discharged from their index hospitalization. 1939 (48%) underwent at least one additional surgical procedure after the index CDH repair. Most performed surgeries were gastrostomy tube (28%), fundoplication (13%), and tracheostomy (5%). Covariates associated with additional surgical morbidity included: prematurity (OR 1.38; 95% CI: 1.20-1.59), cardiac co-morbidity (OR 1.31; 95% CI: 1.14-1.49), and chromosomal anomalies (OR 1.76, 95% CI: 1.30-2.40). Northeast (OR: 2.43; CI 1.42-3.52), Midwest (OR 2.11; 95% CI: 1.45-3.07), and South (OR 1.45, 95% CI 1.02-2.12) regions were associated with additional surgical morbidity. Patients who required additional surgical procedures had longer initial inpatient length of stays (71 versus 31 d) and higher associated costs ($357,000 versus $161,000). CONCLUSIONS Surgical morbidity exists in CDH patients after initial CDH repair. Counseling families on these outcomes is important in establishing expectations for management. Establishing guidelines for optimal surgical management will require continued reporting from multi-institutional studies.

中文翻译：

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先天性膈疝儿童额外手术干预的流行病学和地区差异：多机构分析。


目的 确定先天性膈疝 (CDH) 儿科患者合并症手术治疗的实践差异。背景 CDH 患者存活出院的比例较高，同时需要气管造口术和胃造口管插入等外科手术的发病率也随之增加。该人群中这些合并症的手术治疗频率、趋势和区域差异尚不清楚。方法 确定了美国儿科健康信息系统数据库中 2012 年至 2022 年期间接受 CDH 修复的新生儿。多变量回归确定了 CDH 修复后额外手术发病率的预测因素，即住院期间或出院后一年内的额外手术干预。为了缩小疾病严重程度范围，仅纳入因住院而入住重症监护病房的患者。二次分析比较了各地区的手术频率和医院资源利用率。结果 4003 名患者接受了 CDH 修复并出院。 1939 年（48%）在 CDH 修复后至少接受了一次额外的外科手术。大多数进行的手术是胃造口术（28%）、胃底折叠术（13%）和气管切开术（5%）。与额外手术发病率相关的协变量包括：早产（OR 1.38；95% CI：1.20-1.59）、心脏合并症（OR 1.31；95% CI：1.14-1.49）和染色体异常（OR 1.76，95% CI： 1.30-2.40）。东北部（OR：2.43；CI 1.42-3.52）、中西部（OR 2.11；95% CI：1.45-3.07）和南部（OR 1.45，95% CI 1.02-2.12）地区与额外的手术发病率相关。 需要额外手术的患者初始住院时间更长（71 天对 31 天），相关费用更高（357,000 美元对 161,000 美元）。结论 CDH 患者初次 CDH 修复后存在手术并发症。就这些结果向家庭提供咨询对于建立对管理层的期望非常重要。建立最佳手术管理指南需要多机构研究的持续报告。