Patient Characteristics and Outcomes Following Operative Repair of Acute versus Chronic Traumatic Diaphragmatic Hernia

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 < 0.0001). Acute TDH patients were more likely to be male (46.7% vs 37.2%, p = 0.01) and have concomitant infection (14.0% vs 6.6%, p = 0.0002). Chronic TDH patients were more likely to be obese (55.2% vs 42.8%, p = 0.0004) and have an ASA > 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.

Identification of Delayed Traumatic Diaphragmatic Injury: A Concise Review

“…When the diaphragm sustains a tear, abdominal contents can herniate into the thoracic cavity. A tear in the diaphragm may be missed in the acute phase due to viscera plugging of the tear (Ryu et al, 2017) or positive-pressure ventilation via intubation as positive pressure may mask the diaphragmatic margin (Gribben et al, 2019). Providers and trauma nurses must be aware that mechanical ventilation can have a masking effect on a diaphragmatic tear.…”