S.M. Larabee1,2, S. Peiffer1,2, B. Jeon1,2, T.C. Lee1,2, S.G. Keswani1,2, A. King1,2 1Baylor College of Medicine, Michael E. DeBakey Department Of Surgery, Houston, TEXAS, USA 2Texas Children’s Hospital, Department Of Surgery, Division Of Pediatric Surgery, Houston, TEXAS, USA
Introduction: Congenital diaphragmatic hernias (CDH) can be diagnosed prenatal or antenatal, presenting with a defect in the diaphragm allowing abdominal viscera into the chest and limit lung development. CDH affects 3/10,000 live births with possible long-term sequelae including respiratory compromise from pulmonary hypertension and recurrence. We aim to characterize patients and outcomes of children with CDH in Texas.
Methods: We retrospectively reviewed a statewide hospital inpatient discharge database (2016-2022) to identify patients <18 years with CDH using International Classification of Disease 10 codes, excluding patients transferred to outside hospitals to avoid double-counting. Descriptive statistics and chi-squared tests were performed using STATA.
Results: 1039 admissions with CDH with 41.9% female were identified with 8.9% rural and 8.1% Mexico-US border regions. The majority of admissions were within the first year of life with admissions decreasing with increasing age (<28 day: 319, 30.7%; 28-365 days: 472, 45.4%; 1-4 years: 174, 16.7%; 5-9 years: 37, 3.6%; 10-14 years: 25, 2.4%; 15-17 years: 12, 1.2%). Of newborn patients, 51.8% (220/424) were discharged <28 day of life (DOL), 46.7% (198/424) at 28-365 DOL, and 1.4% (6/424) discharge >1 year of life. There is an overall 16.7% mortality rate with a 40.6% mortality rate at <28 DOL and dropping to 0% over 10 year of age. For patients >1 year of life, inpatient admissions were primarily elective (>1 yr: 40-58.3% elective). However, the majority of these admissions continued to require an ICU admission (>1 yr: 51.1-60.0%). Across all admissions, OR procedures are required regardless of age (<28 days 64.7%; 28-365 days 86.9%; 1-4 year 59.8%; 5-9 year 67.6%; 10-14 year 68.0%; 15-17 year 66.7%). However as age increases, hospital length of stay significantly decreases (<28 days 10d [IQR 1-19]; 28-365 days 46d [IQR 11-87]; 1-4 years 4d [IQR 2-8]; 5-9 year 3d [IQR 2-7]; 10-14 year 4d [IQR 2-6]; 15-17 year 4.5d [IQR 2.5-6.5]) without significant decrease in overall daily admission costs ($16,992 [IQR $11,600-27,000]). The most common associated diagnosis during admission include major chest procedures, ECMO or tracheostomy placement, pleural effusions, and respiratory failure requiring ventilatory support.
Conclusion: Patients with CDH have high early mortality rates and costs due to the need for critical care and surgical repair early in life and continue to have require high levels of care, including operative intervention and critical care admissions to manage the sequela of CDH throughout life. However, the burden of care appears to decrease with shorter hospitalization as patient age increases.