TY - JOUR
T1 - ECMO hospital volume and survival in congenital diaphragmatic hernia repair
AU - Davis, James S.
AU - Ryan, Mark L.
AU - Perez, Eduardo A.
AU - Neville, Holly L.
AU - Bronson, Steven N.
AU - Sola, Juan E.
PY - 2012/12
Y1 - 2012/12
N2 - Purpose: This study examined survival in newborn patients after congenital diaphragmatic hernia (CDH) repair. Methods: We analyzed the Kids' Inpatient Database Years 2000, 2003, and 2006 for patients admitted at fewer than 8 d of age undergoing CDH repair. We analyzed patient demographics, clinical characteristics, socioeconomic measures, hospital type, operative case volume, and survival using Fisher's exact test and a multivariate binary logistic regression model. Results: Of 847 patients identified, most were male (61%) and white (57%), were treated at urban (99.8%) and teaching (96%) hospitals, and had private insurance (57%). Survival to discharge was 95% in non-extracorporeal membrane oxygenation (ECMO) patients versus 51% for those requiring ECMO (P < 0.0001). Univariate analysis revealed significantly lower survival rates in blacks, Medicaid patients, and patients undergoing repair after 7 d of life. Among ECMO patients, we noted higher survival rates at hospitals conducting four or more ECMO cases per year (66% versus 47%; P = 0.03). Multivariate analysis identified ECMO (hazards ratio [HR] 16.23, P < 0.001), CDH repair at >7 d of age (HR 2.70, P = 0.004), and ECMO patients repaired at hospitals performing <4 CDH ECMO cases per year (HR 3.59, P = 0.03) as independent predictors of mortality. Conclusions: We conclude that ECMO hospital volume is associated with survival in patients requiring ECMO for CDH repair.
AB - Purpose: This study examined survival in newborn patients after congenital diaphragmatic hernia (CDH) repair. Methods: We analyzed the Kids' Inpatient Database Years 2000, 2003, and 2006 for patients admitted at fewer than 8 d of age undergoing CDH repair. We analyzed patient demographics, clinical characteristics, socioeconomic measures, hospital type, operative case volume, and survival using Fisher's exact test and a multivariate binary logistic regression model. Results: Of 847 patients identified, most were male (61%) and white (57%), were treated at urban (99.8%) and teaching (96%) hospitals, and had private insurance (57%). Survival to discharge was 95% in non-extracorporeal membrane oxygenation (ECMO) patients versus 51% for those requiring ECMO (P < 0.0001). Univariate analysis revealed significantly lower survival rates in blacks, Medicaid patients, and patients undergoing repair after 7 d of life. Among ECMO patients, we noted higher survival rates at hospitals conducting four or more ECMO cases per year (66% versus 47%; P = 0.03). Multivariate analysis identified ECMO (hazards ratio [HR] 16.23, P < 0.001), CDH repair at >7 d of age (HR 2.70, P = 0.004), and ECMO patients repaired at hospitals performing <4 CDH ECMO cases per year (HR 3.59, P = 0.03) as independent predictors of mortality. Conclusions: We conclude that ECMO hospital volume is associated with survival in patients requiring ECMO for CDH repair.
KW - Congenital diaphragmatic hernia
KW - ECMO
KW - KID
KW - Outcomes
KW - Population-based study
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U2 - 10.1016/j.jss.2012.05.046
DO - 10.1016/j.jss.2012.05.046
M3 - Article
C2 - 22682713
AN - SCOPUS:84869082672
SN - 0022-4804
VL - 178
SP - 791
EP - 796
JO - Journal of Surgical Research
JF - Journal of Surgical Research
IS - 2
ER -