Treatment Facility Case Volume and Disparities in Outcomes of Congenital Diaphragmatic Hernia Cases

Infographic · May 2024 · 1 min read

In brief

Texas statewide study of 1,314 CDH cases shows higher-volume centers achieve lower mortality (18% vs 27%) despite treating sicker patients, while minority populations are disproportionately treated at lower-volume facilities with worse outcomes. Each additional CDH case treated per year correlates with 0.5% decreased mortality odds.

Higher-volume CDH centers (>75 cases) achieve 18% mortality vs 27% at low-volume centers despite treating sicker patients.
Each additional CDH case treated per year reduces mortality odds by 0.5%, supporting regionalization of care.
Hispanic patients and those near the Mexican border are disproportionately treated at low-volume centers with worse outcomes.
ECMO availability concentrated at high-volume centers; only 10% of CDH patients received ECMO across Texas (2013-2021).
Volume-outcome disparity persists after controlling for illness severity, suggesting care quality differences beyond case mix.

Written by the GCMD Library team from the infographic.

The infographic uses a three-panel layout with a red sidebar on the left containing study metadata. The center shows an anatomical illustration of CDH alongside hospital building icons representing high-volume (>75 cases/year) versus low-volume (<20 cases/year) centers. The right panel displays outcome metrics with icons of a gravestone and ECMO machine, using teal arrows to highlight mortality and ECMO usage differences.

New Infographic from the Journal of Pediatric Surgery by the Chilean Society of pediatric surgeons

"Treatment Facility Case Volume and Disparities in Outcomes of Congenital Diaphragmatic Hernia Cases"

Authors: Sarah E. Peiffer, Steven C. Mehl, Paulina Powell, Timothy C. Lee, Sundeep G. Keswani, Alice King

Full article: https://www.jpedsurg.org/article/S0022-3468(24)00074-5/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.

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