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One-year outcomes for congenital diaphragmatic hernia

Y Wang1, K Honeyford1, P Aylin1

  • 1Dr Foster Unit, Department of Primary Care and Public Health, Imperial College London London UK.

BJS Open
|June 12, 2019
PubMed

Insights

Congenital diaphragmatic hernia (CDH) outcomes in England showed no significant time trends but high variation among specialist centers. Further investigation into care regionalization is recommended for this serious congenital anomaly.

Area of Science:

  • Pediatric Surgery
  • Neonatal Outcomes
  • Public Health Surveillance

Background:

  • Congenital diaphragmatic hernia (CDH) is a severe birth defect with significant mortality and long-term health issues.
  • Benchmarking outcomes is crucial for improving care for infants with CDH.

Purpose of the Study:

  • To analyze trends in 1-year survival and hospital volume outcomes for congenital diaphragmatic hernia (CDH) in England.
  • To assess the association between hospital volume and patient outcomes in specialist pediatric surgery centers.

Main Methods:

  • Retrospective analysis of 2336 infants with CDH in England (2003-2016) using Hospital Episode Statistics.
  • Key outcomes measured: 1-year mortality, neonatal length of stay (nLOS), total bed-days, and readmission rates.
  • Statistical analysis to determine associations between risk factors, interventions (e.g., ECMO), and outcomes, including hospital volume.

Main Results:

  • 1-year mortality was 31.2%; no significant time trends in incidence or outcomes were observed.
  • Higher mortality linked to low birthweight (<1kg), early gestational age (≤36 weeks), and Black ethnicity.
  • Extracorporeal membrane oxygenation (ECMO) was associated with increased mortality and resource utilization; significant variation in outcomes and resource use existed among specialist centers without a clear volume-outcome relationship.

Conclusions:

  • Congenital diaphragmatic hernia (CDH) outcomes in England are comparable to other developed nations.
  • High variability in outcomes among specialist pediatric centers warrants further investigation, suggesting potential benefits of care regionalization.
Abstract

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