治疗设施病例量与先天性膈疝病例结局的差异。

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

机构信息

Michael 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.

Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Houston, TX, USA.

出版信息

J Pediatr Surg. 2024 May;59(5):825-831. doi: 10.1016/j.jpedsurg.2024.01.042. Epub 2024 Feb 4.

DOI:10.1016/j.jpedsurg.2024.01.042

PMID:38413264

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.

TYPE OF STUDY

Retrospective Prognosis Study.

LEVEL OF EVIDENCE

Level II.

摘要

引言

先天性膈疝（CDH）是一种危及生命的、产前诊断的先天性异常。我们旨在描述德克萨斯州 CDH 婴儿的护理和结局，并探讨治疗设施数量对其的影响。

方法

使用全州医院住院患者公共使用数据文件进行回顾性队列研究（2013-2021 年）。使用 CDH ICD-9/ICD-10 编码纳入新生儿和 <1 岁的婴儿。排除转至外院的新生儿，以避免重复计数。进行描述性统计、卡方检验和逻辑回归分析。

结果

在 1314 例 CDH 患者中，728 例（55%）在 5 家高容量中心（HVC，>75 例），326 例（25%）在 9 家中等容量中心（MVC，20-75 例），268 例（20%）在 79 家低容量中心（LVC，<20 例）接受治疗。尽管 HVC 治疗的患者病情更严重（极重度疾病严重程度：HVC 为 71%，MVC 为 62%，LVC 为 50%；p<0.001），但死亡率较低（18%，MVC 为 22%，LVC 为 27%；p=0.011），且住院时间更长（p<0.001）。136 例（10%）患者使用体外膜肺氧合（ECMO），主要在 HVC 应用。LVC 治疗的非白西班牙裔患者比例更高（p<0.001），且来自墨西哥边境沿线县的患者更多（p<0.001）。CDH 患者的死亡率预测概率随治疗设施 CDH 病例数量的增加而降低，每增加一例 CDH 病例，死亡率的几率降低 0.5%（p<0.001）。