Clinical outcomes after diaphragm plication for diaphragm paralysis: a single New Zealand centre retrospective cohort study

aim: The aim of this study was to assess clinical outcomes, including breathlessness, after diaphragm plication in patients with symptomatic diaphragm paralysis. methods: A retrospective cohort study of all patients undergoing diaphragm plication at Christchurch Hospital between 1 January 2018 and 31 December 2022 was conducted. Breathlessness was assessed using the Medical Research Council (MRC) dyspnoea scale, derived from clinic letters pre-operatively and at routine post-operative follow-up. Pre- and post-operative MRC scores were compared using paired non-parametric testing. Secondary outcomes included post-operative complications, 30-day readmission and 30- and 90-day mortality. results: There were 37 patients identified who underwent diaphragm plication during the study period. Paired pre- and postoperative MRC scores were available for 32 patients. Median pre-operative MRC score was three (interquartile range [IQR] 3–4), improving to two (IQR 1–2) post-operatively, representing a median improvement of two MRC grades (p<0.001). Breathlessness improved in 31/32 patients (97%), was unchanged in 1/32 (3%) and worsened in none. Post-operative pneumonia occurred in three out of 37 patients (8%), and eight of 37 patients (22%) were readmitted within 30 days. There was no mortality at 30 or 90 days. conclusion: Diaphragm plication was associated with substantial improvement in patient-reported breathlessness and acceptable short-term morbidity in selected symptomatic patients.