Gastrointestinal endoscopy 07/2012; 76(1):185-6. · 6.71 Impact Factor
ABSTRACT: To determine the comparative effectiveness of various approaches to diaphragmatic hernia (DH) repair, including open abdominal, laparoscopic abdominal, and thoracotomy.
Using the Nationwide Inpatient Sample from 1999 to 2008, a comprehensive cohort of 38 764 patients (mean [SD] age, 60.8 [19.5] years) hospitalized with a primary diagnosis of DH who underwent repair was identified.
Morbidity and mortality of patients who underwent DH repair.
Open approaches were the most common, performed in 91% of patients (open abdominal, n=28 824 [74.4%]; thoracotomy, n=6573 [17.0%]). Hospital mortality was 1.1% or less for each of the approaches. However, patients who underwent a laparoscopic DH repair had a shorter length of stay (mean [SD], 4.5 [0.10] days) and fewer discharges to skilled nursing facilities than those who underwent open abdominal or thoracotomy repair approaches. Patients who underwent a DH repair through a thoracotomy approach had the longest length of stay (mean [SD], 7.8 [0.11] days) and a higher need for postoperative mechanical ventilation than those undergoing open or laparoscopic abdominal approaches (5.6% vs 3.2% vs 2.3%, respectively; P.001). In addition, the thoracotomy approach was found to be an independent predictor for the development of a pulmonary embolism.
This large national study demonstrates that most DH repairs are performed through open abdominal and thoracic approaches. Laparoscopic approaches are associated with decreased length of stay and more routine discharges than open abdominal and thoracotomy approaches.
Archives of surgery (Chicago, Ill.: 1960) 03/2012; 147(7):607-12. · 4.32 Impact Factor
ABSTRACT: 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.
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.
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.
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.
The Journal of thoracic and cardiovascular surgery 07/2011; 142(4):747-54. · 3.41 Impact Factor
The Annals of thoracic surgery 04/2011; 91(4):e63. · 3.74 Impact Factor