Related Experiment Video
Updated: Jul 2, 2025
Transuterine Fetal Tracheal Occlusion Model in Mice
Published on: February 5, 2021
Treatment Facility Case Volume and Disparities in Outcomes of Congenital Diaphragmatic Hernia Cases
Sarah E Peiffer1, Steven C Mehl1, Paulina Powell2
1Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA; Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Houston, TX, USA.
Insights
Infants with congenital diaphragmatic hernia (CDH) treated at high-volume centers (HVC) have lower mortality rates. Minority populations are disproportionately treated at low-volume centers (LVC), which are associated with worse outcomes.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Public Health
Background:
- Congenital diaphragmatic hernia (CDH) is a severe, prenatally diagnosed condition in newborns.
- Understanding care variations and outcomes based on treatment facility volume is crucial for improving infant survival.
Purpose of the Study:
- To analyze the care and outcomes of infants with CDH in Texas.
- To assess the impact of hospital treatment volume on CDH patient outcomes.
Main Methods:
- Retrospective cohort study (2013-2021) using Texas Inpatient Discharge Public Use Data File.
- Inclusion of neonates and infants under 1 year with CDH diagnoses (ICD-9/ICD-10 codes).
- Exclusion of transferred neonates to prevent data duplication; statistical analyses included descriptive statistics, chi-square, and logistic regression.
Main Results:
- Higher volume centers (HVC) demonstrated lower mortality (18%) compared to mid-volume (MVC, 22%) and low-volume centers (LVC, 27%).
- HVC managed sicker patients (71% extreme illness severity) with longer lengths of stay, utilizing extracorporeal membrane oxygenation (ECMO) more frequently.
- LVC disproportionately served non-white Hispanic patients and those from border counties, correlating with worse outcomes.
Conclusions:
- Treatment at HVC is associated with significantly lower mortality for CDH patients, even with higher illness severity.
- Disparities in care exist, with minority populations potentially receiving care at LVC, leading to poorer outcomes.
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.
