Our Summary

This research paper looks at the factors that cause patients to go back to the hospital after having surgery to fix a birth defect called congenital diaphragmatic hernia (CDH), which affects the diaphragm. The researchers used a national database from 2010 to 2014 to find patients who had this surgery. They found that out of 511 patients, 32% had to be readmitted to the hospital within 30 days, and 97% within a year. The main reasons for readmission were complications related to acid reflux, the CDH coming back, or needing surgery for a feeding tube or for the upper part of the stomach. They also found that the CDH was more likely to come back in patients who had minimally invasive surgery (MIS), a type of surgery that uses small cuts instead of one large one, compared to those who had open surgery. This is the first study to look at nationwide readmissions in newborns with CDH.

FAQs

  1. What are the main reasons for patients being readmitted to the hospital after congenital diaphragmatic hernia repair surgery?
  2. Is the congenital diaphragmatic hernia more likely to reoccur in patients who had minimally invasive surgery versus those who had open surgery?
  3. What percentage of patients had to be readmitted to the hospital within a year of having congenital diaphragmatic hernia repair surgery?

Doctor’s Tip

A helpful tip a doctor might give to a patient about congenital diaphragmatic hernia repair is to closely follow post-operative care instructions, including taking any prescribed medications, attending follow-up appointments, and monitoring for any signs of complications such as acid reflux or recurrence of the hernia. It is important to communicate any concerns or changes in symptoms to your healthcare provider promptly to ensure the best possible outcome after surgery.

Suitable For

Patients who are typically recommended congenital diaphragmatic hernia repair are newborns or infants who have been diagnosed with CDH. These patients may experience symptoms such as difficulty breathing, cyanosis (bluish skin color), rapid breathing, and a protruding abdomen. Surgery is usually recommended to repair the hole in the diaphragm and prevent the abdominal organs from moving into the chest cavity, which can lead to respiratory and digestive complications. In some cases, surgery may be delayed if the baby is stable and able to tolerate medical management until they are older and better able to tolerate surgery.

Timeline

  • Before CDH repair:
  1. Diagnosis of congenital diaphragmatic hernia through prenatal ultrasound or after birth
  2. Monitoring of the baby’s condition and lung development
  3. Possible placement on a ventilator or ECMO (extracorporeal membrane oxygenation) to support breathing
  4. Evaluation by a multidisciplinary team of specialists to plan for surgery
  • After CDH repair:
  1. Surgery to repair the diaphragmatic hernia, either through open surgery or minimally invasive surgery
  2. Recovery in the hospital with monitoring of breathing, feeding, and overall health
  3. Potential complications such as acid reflux, recurrence of CDH, or need for additional surgeries
  4. Follow-up appointments with healthcare providers to monitor the baby’s growth and development
  5. Possible readmission to the hospital within 30 days or within a year for complications or further treatment

Overall, the timeline for a patient with congenital diaphragmatic hernia involves a combination of preoperative evaluation, surgical repair, postoperative recovery, and ongoing monitoring for potential complications.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with CDH repair surgery?
  2. What is the likelihood of the CDH coming back after surgery?
  3. Will I need any additional surgeries or procedures after the initial repair?
  4. How long is the recovery process expected to be, and what should I expect during this time?
  5. Are there any specific dietary or lifestyle changes I should make to reduce the risk of complications or readmission?
  6. What signs or symptoms should I watch out for that may indicate a need for urgent medical attention?
  7. Are there any long-term implications or concerns I should be aware of following CDH repair surgery?
  8. How often will follow-up appointments be needed to monitor my recovery and overall health?
  9. Are there any specific precautions I should take to protect the surgical site and prevent infection?
  10. What is the success rate of CDH repair surgery, and what factors may affect the outcome of the procedure?

Reference

Authors: Cioci AC, Urrechaga EM, Parreco J, Remer LF, Cowan M, Perez EA, Sola JE, Thorson CM. Journal: J Pediatr Surg. 2021 Sep;56(9):1542-1546. doi: 10.1016/j.jpedsurg.2020.09.018. Epub 2020 Oct 1. PMID: 33268050