Treating Center Volume and Congenital Diaphragmatic Hernia Outcomes in California - 27/01/21
, Zachary J. Kastenberg, MD 1, 3, Alexander T. Gibbons, MD 2, Suzan L. Carmichael, PhD 4, 5, Henry C. Lee, MD 5, 6, Karl G. Sylvester, MD 1, 3, 4, 5Abstract |
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.
Le texte complet de cet article est disponible en PDF.Abbreviations : CDH, CPQCC, ECMO, NICU, VLBW
Plan
| Funded by the Stanford Medical Scholar Research Program. The authors declare no conflicts of interest. |
|
| This study was presented at the American Academy of Pediatrics National Conference & Exhibition, September 15, 2017, Chicago, IL. |
Vol 222
P. 146 - juillet 2020 Retour au numéro
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