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

New article you should know from the Journal of Pediatric Surgery, selected by the Chilean Society of pediatric surgeons, Summarized by Dr. Cecilia Gigena

"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.