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Treating Center Volume and Congenital Diaphragmatic Hernia Outcomes in California.

CPQCC Publication
TitleTreating Center Volume and Congenital Diaphragmatic Hernia Outcomes in California.
Publication TypeJournal Article
Year of Publication2020
AuthorsApfeld JC, Kastenberg ZJ, Gibbons AT, Carmichael SL, Lee HC, Sylvester KG
JournalJ Pediatr
Date Published2020 07
KeywordsCalifornia, Extracorporeal Membrane Oxygenation, Female, Hernias, Diaphragmatic, Congenital, Humans, Incidence, Infant, Newborn, Intensive Care Units, Neonatal, Male, Retrospective Studies, Treatment Outcome

OBJECTIVE: To examined outcomes for infants born with congenital diaphragmatic hernias (CDH), according to specific treatment center volume indicators.

STUDY DESIGN: A population-based retrospective cohort study was conducted involving neonatal intensive care units in California. Multivariable analysis was used to examine the outcomes of infants with CDH including mortality, total days on ventilation, and respiratory support at discharge. Significant covariables of interest included treatment center surgical and overall neonatal intensive care unit volumes.

RESULTS: There were 728 infants in the overall CDH cohort, and 541 infants (74%) in the lower risk subcohort according to a severity-weighted congenital malformation score and never requiring extracorporeal membrane oxygenation. The overall cohort mortality was 28.3% (n = 206), and 19.8% (n = 107) for the subcohort. For the lower risk subcohort, the adjusted odds of mortality were significantly lower at treatment centers with higher CDH repair volume (OR, 0.41; 95% CI, 0.23-0.75; P = .003), ventilator days were significantly lower at centers with higher thoracic surgery volume (OR, 0.56; 9 5% CI, 0.33-0.95; P = .03), and respiratory support at discharge trended lower at centers with higher neonatal intensive care unit admission volumes (OR, 0.51; 9 5% CI, 0.26-1.02; P = .06).

CONCLUSIONS: Overall and surgery-specific institutional experience significantly contribute to optimized outcomes for infants with CDH. These data and follow-on studies may help inform the ongoing debate over the optimal care setting and relevant quality indicators for newborn infants with major surgical anomalies.

Alternate JournalJ Pediatr
PubMed ID32418817
PubMed Central IDPMC7546600
Grant ListR01 MD007796 / MD / NIMHD NIH HHS / United States