A. N. Bowder1, K. Somers1, M. Arca2, S. Siddiqui1 1Children’s Hospital Of Wisconsin,Pediatric Surgery,Milwaukee, WI, USA 2University Of Rochester Medical Center,Pediatric Surgery,Rochester, NY, USA
Introduction: Placement of a tube thoracostomy during repair of a congenital diaphragmatic hernia is controversial. Minimal data exists comparing the outcomes between patients who receive an intraoperatively placed chest drain (IOCD) and those that do not have drains (NoD) placed during repair of congenital diaphragmatic hernias. In this study we compare postoperative outcomes between patients who underwent congenital diaphragmatic hernia repair with and without intraoperative chest drain placement.
Methods: A retrospective review of infants (age <28 days) who underwent congenital diaphragmatic hernia repair between 2004-2018 was completed. Demographic, operative, and post-operative outcomes were collected. We compared the number of chest tube days, number of ventilator days, days on narcotic pain medications, incidence of post-operative chylothorax, and pleural or patch infection between the two patient groups.
Results:There were 53 patients who underwent congenital diaphragmatic hernia repair. There was no statistically significant difference in estimated gestational age, weight, gender, or age at operation between patients who received an IOCD (25) and those who did not (NoD =28).IOCD patients had both more days of drainage as well as more postoperative chest drainage procedures than NoD patients. Patients who received IOCD kept their index tubes for a median of 6 days, with an initial total of 111 chest drain days in the 25-patient cohort. Seven (28%) of these patients required a second chest tube placed for 101 additional chest drain days. In contrast, only four (14%) patients in the NoD group required some form of chest drainage in the postoperative period. These four patients kept their drains for median length of 4 days, with a total of 20 days of chest drain placement in this cohort. Patients who received IOCD were less likely to have prenatal diagnosis and prenatal surgical consultation and were more likely to have type A defects. These patients also did not receive preoperative steroids, did not require closure with a patch, nor did they require temporary abdominal closure. Patients with IOCD also had fewer ventilator days (10 days) and shorter course of narcotic utilization (24 days) compared to NoD patients (12 and 35 days). This difference was not statistically significant (p <0.08). There was no difference between the incidence of postoperative infections or chylothorax between each group.
Conclusion:In our study population intraoperative chest tubes were associated with more chest drainage days and an increased incidence of second chest drainage procedures; however, they were also associated with shorter periods on the ventilator and shorter durations of narcotic pain medication administration.