Giant Omphaloceles-Morbidity, Mortality, and Financial Impact of Early Versus Delayed Repair.

Autor: Menchaca AD; Center for Regenerative Medicine, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; Department of General Surgery, Indiana University, Indianapolis, Indiana., Style CC; Center for Regenerative Medicine, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio., Chawla M; Center for Regenerative Medicine, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; The Ohio State University College of Medicine, Columbus, Ohio., Kenney BD; Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio; Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio., Diefenbach KA; Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio; Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio., Olutoye OO; Center for Regenerative Medicine, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio; Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio. Electronic address: oolutoye@nationwidechildrens.org.
Jazyk: angličtina
Zdroj: The Journal of surgical research [J Surg Res] 2023 Nov; Vol. 291, pp. 342-351. Date of Electronic Publication: 2023 Jul 26.
DOI: 10.1016/j.jss.2023.06.022
Abstrakt: Introduction: We compared strategy outcomes and financial impact over the first two years of life (F2YOL) for patients with giant omphaloceles undergoing early repair (ER) (primary or staged) versus delayed repair (DR).
Methods: A retrospective review of giant omphaloceles (fascial defect > 5 cm/> 50% liver herniation) at a tertiary children's hospital between 1/1/2010 and 12/31/2019 was performed. Survival, length of stay, age at repair, ventilation days (VD), time to full enteral feeds, readmissions during the F2YOL, incidence of major associated anomalies, and total hospitalization charges during the F2YOL were compared. A subanalysis removing potential confounders and only including patients who underwent fascial closure within the F2YOL was also conducted.
Results: Thirty four giant omphaloceles (23DR and 11ER) were identified. The median age (days) at repair was 289 [148, 399] DR versus 10 [5, 21] ER, P < 0.001. Total cohort two-year survival was significantly higher in the DR group (95.7% versus 63.6%, P = 0.03). Including patients with a tracheostomy there was no significant difference in VD during the index hospitalization. Excluding tracheostomy patients, the DR group had significantly fewer VD during the index hospitalization, 15 [0, 15] versus 18 [10, 54], P = 0.02 and over the F2YOL 6.5 [ 0, 21] versus 18 [14, 43], P = 0.03. There were no significant differences in the incidence/type of major associated anomalies, time to full enteral feeds, index length of stay, total hospital days, total admissions, or associated hospital charges. On subanalysis, there was no significant difference in VD or survival at any time.
Conclusions: Delayed and early repair strategies for giant omphaloceles have equivalent outcomes in the index hospitalization and over the course of the first two years of life. These findings are useful for family counseling and expectation setting.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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