Abstract
Background: Diaphragmatic hernia is a complication of trauma that may lead to significant morbidity and mortality if unrecognized. The clinical sequelae following missed traumatic diaphragmatic hernia (TDH) diagnoses have not been well-defined. Methods: The 2005–2015 ACS-NSQIP databases were accessed to identify patients ≥18 years old who underwent operative repair of acute and chronic TDH. Patient demographics, health characteristics, pertinent complications, and 30-day outcomes were collected. Categorical variables were analyzed using chi-square and Fisher’s Exact Test. Logistic regression was used to perform multivariate analyses with odds ratios (OR) and 95% confidence intervals (CI) constructed about group differences. Results: From 2005–2015, 1000 patients underwent operative repair for TDH, of which 285 (28.5%) were acute and 715 (71.5%) were chronic. Patients undergoing acute repairs had a greater percentage of emergency procedures (29.8% vs. 10.2%, p 2 (51.2% vs 43.2%, p = 0.02). Acute TDH patients were more likely to develop postoperative wound infection (1.40% vs 0.28%, p = 0.05), infectious process (11.2% versus 7.0%, p = 0.03), failure to wean from mechanical ventilation (8.1% vs 3.4%, p = 0.0015), and remain hospitalized at 30 days (4.3% vs 0.9%, p = 0.0058). Conclusions: Patients with acute TDH repair are more likely to develop postoperative complications. Further study is necessary to determine the optimal timing of surgery for TDH discovered following initial resuscitation and evaluation.
Highlights
Diaphragmatic hernia is a rare but serious complication of trauma that may lead to significant morbidity and mortality if unrecognized
The most frequent postoperative diagnoses according to primary ICD-9 codes were diaphragmatic hernia without obstruction, diaphragmatic hernia with obstruction or gangrene, morbid and unspecified obesity, and esophageal reflux (Table 1)
Patients undergoing acute diaphragmatic hernia repairs had a greater percentage of emergency surgery cases (29.8% vs. 10.2%, p < 0.0001), while patients with chronic repairs had a greater percentage of elective surgery cases (51.2% vs. 29.5%, p < 0.0001)
Summary
Diaphragmatic hernia is a rare but serious complication of trauma that may lead to significant morbidity and mortality if unrecognized. The true incidence of traumatic diaphragmatic hernia (TDH) remains uncertain as the wide variety in clinical presentations leads to diagnostic challenges [1, 2, 5,6,7,8]. The clinical sequelae following missed traumatic diaphragmatic hernia (TDH) diagnoses have not been well-defined. Acute TDH patients were more likely to develop postoperative wound infection (1.40% vs 0.28%, p = 0.05), infectious process (11.2% versus 7.0%, p = 0.03), failure to wean from mechanical ventilation (8.1% vs 3.4%, p = 0.0015), and remain hospitalized at 30 days (4.3% vs 0.9%, p = 0.0058). Conclusions: Patients with acute TDH repair are more likely to develop postoperative complications. Further study is necessary to determine the optimal timing of surgery for TDH discovered following initial resuscitation and evaluation
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