Institute for Research in Operative Medicine, Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, 51109 Cologne, Germany; Medical Consultancy Department, Federal Joint Committee, Gutenbergstraße 13, 10587, Berlin, Germany.
Institute for Research in Operative Medicine, Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, 51109 Cologne, Germany.
J Pediatr Surg. 2020 Dec;55(12):2555-2565. doi: 10.1016/j.jpedsurg.2020.03.025. Epub 2020 Apr 1.
Congenital diaphragmatic hernia (CDH) is a rare and life-threatening anomaly that needs surgical therapy after clinical stabilization of the neonate. Given an existing volume-outcome relationship for other high-risk, low volume procedures, we aimed at examining the relationship between hospital or surgeon volume and outcomes for surgery on CDH.
We conducted a systematic search in multiple databases in September 2019 and searched for additional literature. We assessed risk of bias of included studies using ROBINS-I and synthesized results in a structured narrative way using GRADE.
We included 5 cohort studies on hospital volume. Results for in-hospital mortality, one-year mortality and length of stay are inconclusive. The certainty of the evidence was very low for all outcomes, due to risk of bias, inconsistency and imprecision. We did not identify any study on surgeon volume.
Due to the very low certainty of the evidence it is uncertain whether higher hospital volume is associated with favorable outcomes for neonates undergoing surgery for CDH. There is no evidence on the relationship between surgeon volume and outcomes. Future studies should use more rigorous methodology and analyze additional outcomes to allow for more meaningful inferences.
III SYSTEMATIC REVIEW REGISTRATION: PROSPERO (CRD42018090231).
先天性膈疝 (CDH) 是一种罕见且危及生命的异常，需要在新生儿临床稳定后进行手术治疗。鉴于其他高风险、低容量手术已经存在量效关系，我们旨在研究医院或外科医生手术量与 CDH 手术结果之间的关系。
我们于 2019 年 9 月在多个数据库中进行了系统搜索，并搜索了其他文献。我们使用 ROBINS-I 评估了纳入研究的偏倚风险，并使用 GRADE 以结构化叙述的方式综合结果。
我们纳入了 5 项关于医院量的队列研究。住院死亡率、一年死亡率和住院时间的结果尚无定论。由于偏倚风险、不一致性和不精确性，所有结果的证据确定性都非常低。我们没有发现任何关于外科医生量的研究。
由于证据的确定性非常低，因此尚不确定较高的医院量是否与接受 CDH 手术的新生儿的良好结果相关。没有关于外科医生量与结果之间关系的证据。未来的研究应使用更严格的方法，并分析其他结果，以便进行更有意义的推断。
III 系统评价注册：PROSPERO（CRD42018090231）。
