Surgical Repair of Congenital Diaphragmatic Hernia after Extracorporeal Membrane Oxygenation Cannulation: Early Repair Improves Survival

Duy T. Dao, Carmen M. Burgos, Matthew T. Harting, Kevin P. Lally, Pamela A. Lally, Hong An T. Nguyen, Jay M. Wilson, Terry L. Buchmiller

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: To determine the optimal timing of congenital diaphragmatic hernia (CDH) repair after extracorporeal membrane oxygenation (ECMO) cannulation Summary Background Data: The timing of CDH repair after ECMO cannulation remains a controversial topic due to studies with low power or strong selection bias. Methods: This is a 2-aim retrospective cohort study based on the CDH Study Group registry for the period of 2007-2017. Aim 1 - Compare On versus After ECMO repair. Aim 2 - Compare Early versus Late repair on ECMO. In order to minimize selection bias and account for non-repairs, subjects in each aim were stratified into study groups based on their treatment center's characteristics. In each aim, the study groups were matched based on propensity score (PS). The main outcomes included mortality rate and incidence of non-repair. Results: In aim 1, 136 patients remained in each group after PS matching. Compared to the After ECMO group, patients in the On ECMO group demonstrated a lower mortality rate, hazard ratio (HR) 0.54 (0.38, 0.77) (P < 0.001), and lower incidence of non-repair, 5.9% versus 33.8% (P < 0.001). In aim 2, 77 patients remained in each group after PS matching. Compared to the Late group, Early repair of CDH on ECMO was associated with a lower mortality rate, HR 0.51 (0.33, 0.77) (P = 0.002), and lower incidence of non-repair, 9.1% versus 44.2% (P < 0.001). Conclusions: The approach of early repair after ECMO cannulation is associated with improved survival compared to delayed surgical correction.

Original languageEnglish (US)
JournalAnnals of Surgery
DOIs
StateAccepted/In press - Jan 1 2019
Externally publishedYes

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Extracorporeal Membrane Oxygenation
Catheterization
Survival
Propensity Score
Selection Bias
Herniorrhaphy
Mortality
Incidence
Congenital Diaphragmatic Hernias
Registries
Cohort Studies
Research Design
Retrospective Studies

Keywords

  • congenital diaphragmatic hernia
  • extracorporeal membrane oxygenation
  • propensity score matching

ASJC Scopus subject areas

  • Surgery

Cite this

Surgical Repair of Congenital Diaphragmatic Hernia after Extracorporeal Membrane Oxygenation Cannulation : Early Repair Improves Survival. / Dao, Duy T.; Burgos, Carmen M.; Harting, Matthew T.; Lally, Kevin P.; Lally, Pamela A.; Nguyen, Hong An T.; Wilson, Jay M.; Buchmiller, Terry L.

In: Annals of Surgery, 01.01.2019.

Research output: Contribution to journalArticle

Dao, Duy T. ; Burgos, Carmen M. ; Harting, Matthew T. ; Lally, Kevin P. ; Lally, Pamela A. ; Nguyen, Hong An T. ; Wilson, Jay M. ; Buchmiller, Terry L. / Surgical Repair of Congenital Diaphragmatic Hernia after Extracorporeal Membrane Oxygenation Cannulation : Early Repair Improves Survival. In: Annals of Surgery. 2019.
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title = "Surgical Repair of Congenital Diaphragmatic Hernia after Extracorporeal Membrane Oxygenation Cannulation: Early Repair Improves Survival",
abstract = "Objective: To determine the optimal timing of congenital diaphragmatic hernia (CDH) repair after extracorporeal membrane oxygenation (ECMO) cannulation Summary Background Data: The timing of CDH repair after ECMO cannulation remains a controversial topic due to studies with low power or strong selection bias. Methods: This is a 2-aim retrospective cohort study based on the CDH Study Group registry for the period of 2007-2017. Aim 1 - Compare On versus After ECMO repair. Aim 2 - Compare Early versus Late repair on ECMO. In order to minimize selection bias and account for non-repairs, subjects in each aim were stratified into study groups based on their treatment center's characteristics. In each aim, the study groups were matched based on propensity score (PS). The main outcomes included mortality rate and incidence of non-repair. Results: In aim 1, 136 patients remained in each group after PS matching. Compared to the After ECMO group, patients in the On ECMO group demonstrated a lower mortality rate, hazard ratio (HR) 0.54 (0.38, 0.77) (P < 0.001), and lower incidence of non-repair, 5.9{\%} versus 33.8{\%} (P < 0.001). In aim 2, 77 patients remained in each group after PS matching. Compared to the Late group, Early repair of CDH on ECMO was associated with a lower mortality rate, HR 0.51 (0.33, 0.77) (P = 0.002), and lower incidence of non-repair, 9.1{\%} versus 44.2{\%} (P < 0.001). Conclusions: The approach of early repair after ECMO cannulation is associated with improved survival compared to delayed surgical correction.",
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T2 - Early Repair Improves Survival

AU - Dao, Duy T.

AU - Burgos, Carmen M.

AU - Harting, Matthew T.

AU - Lally, Kevin P.

AU - Lally, Pamela A.

AU - Nguyen, Hong An T.

AU - Wilson, Jay M.

AU - Buchmiller, Terry L.

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N2 - Objective: To determine the optimal timing of congenital diaphragmatic hernia (CDH) repair after extracorporeal membrane oxygenation (ECMO) cannulation Summary Background Data: The timing of CDH repair after ECMO cannulation remains a controversial topic due to studies with low power or strong selection bias. Methods: This is a 2-aim retrospective cohort study based on the CDH Study Group registry for the period of 2007-2017. Aim 1 - Compare On versus After ECMO repair. Aim 2 - Compare Early versus Late repair on ECMO. In order to minimize selection bias and account for non-repairs, subjects in each aim were stratified into study groups based on their treatment center's characteristics. In each aim, the study groups were matched based on propensity score (PS). The main outcomes included mortality rate and incidence of non-repair. Results: In aim 1, 136 patients remained in each group after PS matching. Compared to the After ECMO group, patients in the On ECMO group demonstrated a lower mortality rate, hazard ratio (HR) 0.54 (0.38, 0.77) (P < 0.001), and lower incidence of non-repair, 5.9% versus 33.8% (P < 0.001). In aim 2, 77 patients remained in each group after PS matching. Compared to the Late group, Early repair of CDH on ECMO was associated with a lower mortality rate, HR 0.51 (0.33, 0.77) (P = 0.002), and lower incidence of non-repair, 9.1% versus 44.2% (P < 0.001). Conclusions: The approach of early repair after ECMO cannulation is associated with improved survival compared to delayed surgical correction.

AB - Objective: To determine the optimal timing of congenital diaphragmatic hernia (CDH) repair after extracorporeal membrane oxygenation (ECMO) cannulation Summary Background Data: The timing of CDH repair after ECMO cannulation remains a controversial topic due to studies with low power or strong selection bias. Methods: This is a 2-aim retrospective cohort study based on the CDH Study Group registry for the period of 2007-2017. Aim 1 - Compare On versus After ECMO repair. Aim 2 - Compare Early versus Late repair on ECMO. In order to minimize selection bias and account for non-repairs, subjects in each aim were stratified into study groups based on their treatment center's characteristics. In each aim, the study groups were matched based on propensity score (PS). The main outcomes included mortality rate and incidence of non-repair. Results: In aim 1, 136 patients remained in each group after PS matching. Compared to the After ECMO group, patients in the On ECMO group demonstrated a lower mortality rate, hazard ratio (HR) 0.54 (0.38, 0.77) (P < 0.001), and lower incidence of non-repair, 5.9% versus 33.8% (P < 0.001). In aim 2, 77 patients remained in each group after PS matching. Compared to the Late group, Early repair of CDH on ECMO was associated with a lower mortality rate, HR 0.51 (0.33, 0.77) (P = 0.002), and lower incidence of non-repair, 9.1% versus 44.2% (P < 0.001). Conclusions: The approach of early repair after ECMO cannulation is associated with improved survival compared to delayed surgical correction.

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