Recurrence in congenital diaphragmatic hernia: A multicenter, postdischarge pilot study

Abstract

Background

The Congenital Diaphragmatic Hernia Study Group has previously identified factors associated with early hernia recurrence, but multicenter data on postdischarge outcomes were lacking. The purpose of this study is to assess diaphragmatic hernia recurrence rates in the first 5 years of life using a multicenter cohort.

Methods

A database was established with data from 4 centers collected retrospectively at perinatal, discharge, 2 years, and 5 years. The study included patients with congenital diaphragmatic hernia managed in the outpatient setting between 2010 and 2021. The primary outcome was recurrence of congenital diaphragmatic hernia requiring operative correction.

Results

Of the 472 infants with congenital diaphragmatic hernia identified, 297 (81%) had long-term follow-up data: 241 patients were followed up at 2 years and 113 at 5 years. Recurrence occurred in 35 (12%) patients, with higher rates in high-risk (17%) versus low-risk (8%) patients. Extracorporeal life support was associated with increased recurrence (23% vs 10%, predicted to be 32.0% vs 5.8%), and minimally invasive surgery repair had a higher recurrence rate (35% vs 7% for open repair, predicted to be 26.0% vs 6.3%). No difference in recurrence rates was found between patch and primary repair. The model predicted 5-year recurrence rates, higher than the observed rates, of 11.6%, 9.5%, 27.3%, and 33.0% for Congenital Diaphragmatic Hernia Study Group A–D stages, respectively.

Conclusion

Congenital diaphragmatic hernia defect size, extracorporeal life support, and minimally invasive surgery repair were associated with postdischarge recurrence. Smaller defects tend to recur earlier, whereas larger defects have a steady recurrence rate over 5 years. These findings should guide patient counseling and follow-up planning.