Treatment Facility Case Volume and Disparities in Outcomes of Congenital Diaphragmatic Hernia Cases.
J Pediatr Surg
; 59(5): 825-831, 2024 May.
Article
em En
| MEDLINE
| ID: mdl-38413264
ABSTRACT
INTRODUCTION:
Congenital diaphragmatic hernia (CDH) is a life-threatening, prenatally diagnosed congenital anomaly. We aim to characterize care and outcomes of infants with CDH in Texas and the impact of treating facilities volume of care.METHODS:
Retrospective cohort study using a state-wide Hospital Inpatient Discharge Public Use Data File was conducted (2013-2021). Neonates and infants <1 year of age were included using CDH ICD-9/ICD-10 codes. Neonates transferred to an outside hospital were excluded to avoid double-counting. Descriptive statistics, chi-square and logistic regression analysis were performed.RESULTS:
Of 1314 CDH patient encounters identified, 728 (55%) occurred at 5 higher volume centers (HVC, >75 cases), 326 (25%) at 9 mid-volume centers (MVC, 20-75 cases) and 268 (20%) at 79 low volume centers (LVC, <20 cases). HVC had lower mortality rates (18%, MVC 22% vs LVC 27%; p = 0.011) despite treating sicker patients (extreme illness severity HVC 71%, MVC 62% vs LVC 50%; p < 0.001) with longer length-of-stay (p < 0.001). Extracorporeal membrane oxygenation was used in 136 (10%) and provided primarily at HVC. LVC treated proportionately more non-white Hispanic patients (p < 0.001) and patients from counties along the Mexican border (p < 0.001). The predicted probability of mortality in CDH patients decreases with higher treatment facility CDH case volume, with a 0.5% decrease in the odds of mortality for every additional CDH case treated (p < 0.001).CONCLUSIONS:
Patients treated in HVC have significantly lower mortality despite increased severity. Our data suggest minority populations may be disproportionately treated at LVC associated with worse outcomes. TYPE OF STUDY Retrospective Prognosis Study. LEVEL OF EVIDENCE Level II.Palavras-chave
Texto completo:
1
Temas:
ECOS
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Equidade_desigualdade
Bases de dados:
MEDLINE
Assunto principal:
Oxigenação por Membrana Extracorpórea
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Hérnias Diafragmáticas Congênitas
Limite:
Humans
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Infant
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Newborn
Idioma:
En
Revista:
J Pediatr Surg
Ano de publicação:
2024
Tipo de documento:
Article
País de afiliação:
Estados Unidos