TY - JOUR
T1 - Prevalence, outcomes, and a risk-benefit analysis of diaphragmatic hernia admissions
T2 - An examination of the National Inpatient Sample database
AU - Paul, Subroto
AU - Mirza, Farooq M.
AU - Nasar, Abu
AU - Port, Jeffrey L.
AU - Lee, Paul C.
AU - Stiles, Brendon M.
AU - Nguyen, Andrew B.
AU - Sedrakyan, Art
AU - Altorki, Nasser K.
PY - 2011/10
Y1 - 2011/10
N2 - Objective: Current practice is to repair uncomplicated diaphragmatic hernias (UDHs) to avoid complications such as obstruction or gangrene. However, practice patterns are based on limited data. We analyzed the National Inpatient Sample to compare outcomes of patients with obstructed (ODH) or gangrenous (GDH) diaphragmatic hernias and those who underwent repair of UDHs to perform a risk-benefit analysis of observation versus elective repair. Patients and Methods: We queried the National Inpatient Sample for hospitalized patients who underwent a UDH repair as the principal procedure during their admission. To this repair group, we compared the outcomes of those patients who had a diagnosis of GDH or ODH. A risk-benefit analysis of observation versus elective repair was performed based on these data. Results: Over a 10-year period, 193,554 admissions for the diagnosis of diaphragmatic hernia were identified. A UDH was the diagnosis in 161,777 (83.6%) admissions with 38,764 (24.0%) admissions for elective repair. ODH or GDH was the reason for admission in 31,127 (16.1%) and 651 (0.3%), respectively. Compared with patients who underwent elective repair, mortality was higher in patients with ODH or GDH (1% vs 4.5%; P < .001; and 1% vs 27.5%; P < .001). Risk-benefit analysis suggested a small but real benefit to elective repair in patients aged 50 to 70 years or if the operative mortality is 1% or less. Conclusions: Elective UDH repair is associated with better outcomes than admissions for ODH or GDH with a favorable risk-benefit profile than observation if the operative mortality is low.
AB - Objective: Current practice is to repair uncomplicated diaphragmatic hernias (UDHs) to avoid complications such as obstruction or gangrene. However, practice patterns are based on limited data. We analyzed the National Inpatient Sample to compare outcomes of patients with obstructed (ODH) or gangrenous (GDH) diaphragmatic hernias and those who underwent repair of UDHs to perform a risk-benefit analysis of observation versus elective repair. Patients and Methods: We queried the National Inpatient Sample for hospitalized patients who underwent a UDH repair as the principal procedure during their admission. To this repair group, we compared the outcomes of those patients who had a diagnosis of GDH or ODH. A risk-benefit analysis of observation versus elective repair was performed based on these data. Results: Over a 10-year period, 193,554 admissions for the diagnosis of diaphragmatic hernia were identified. A UDH was the diagnosis in 161,777 (83.6%) admissions with 38,764 (24.0%) admissions for elective repair. ODH or GDH was the reason for admission in 31,127 (16.1%) and 651 (0.3%), respectively. Compared with patients who underwent elective repair, mortality was higher in patients with ODH or GDH (1% vs 4.5%; P < .001; and 1% vs 27.5%; P < .001). Risk-benefit analysis suggested a small but real benefit to elective repair in patients aged 50 to 70 years or if the operative mortality is 1% or less. Conclusions: Elective UDH repair is associated with better outcomes than admissions for ODH or GDH with a favorable risk-benefit profile than observation if the operative mortality is low.
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U2 - 10.1016/j.jtcvs.2011.06.038
DO - 10.1016/j.jtcvs.2011.06.038
M3 - Article
C2 - 21803376
AN - SCOPUS:80052867480
SN - 0022-5223
VL - 142
SP - 747
EP - 754
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 4
ER -