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Background <p>This study examined inter-center variation (ICV) in inpatient outcomes for infants with congenital diaphragmatic hernia (CDH), aiming to contribute to quality metrics and clinical benchmarks in neonatal care.</p> Methods <p>We retrospectively analyzed CDH cases from the Children’s Hospitals Neonatal Consortium (CHNC) database (2010–2022), focusing on infants without prior surgical repair or discharge. Our outcomes of interest included inpatient survival, survival without ECMO, and hospital length of stay (LOS). We incorporated centers with ≥30 cases into multivariable models to adjust for patient and clinical factors.</p> Results <p>Analysis of 3639 infants revealed significant ICV. Unadjusted inpatient survival rate was 76.5%, with ICV ranging from 55.4% to 90.7%. The composite outcome of survival without ECMO was 63.3% (ICV: 38.6–87.9%). The median LOS for survivors was 50 days (ICV: 29–68 days). Multivariable analyses confirmed these trends, indicating an 18-fold variation in survival, a 35-fold variation in survival without ECMO, and a 3.3-fold variation in LOS across centers (<i>p</i> &lt; 0.001 for all).</p> Conclusion <p>The treating center was a significant predictor of risk-adjusted inpatient outcomes for infants with CDH. These findings highlight substantial disparities in care and support the integration of these metrics into future research and quality improvement efforts in level IV NICUs.</p> Impact statement <p><UnorderedList Mark="Bullet"> <ItemContent> <p>This study reveals considerable inter-center differences in CDH outcomes, contributing extensive, multicenter data to the existing body of literature. It underscores how center-specific practices affect survival and ECMO use, suggesting that organized high-level care could enhance outcomes for CDH patients. These insights lay the groundwork for center-specific quality improvement initiatives to elevate the standard of care.</p> </ItemContent> </UnorderedList></p>

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Congenital diaphragmatic hernia outcomes: navigating center-to-center variability in level 4 NICUs in the Children’s Hospitals Neonatal Consortium

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年2月25日

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  • Yigit S. Guner,
  • Isabella Zaniletti,
  • Theresa R. Grover,
  • Sharada H. Gowda,
  • Nicolas F. M. Porta,
  • Michael A. Padula,
  • Sarah Keene,
  • Burhan Mahmood,
  • Jacquelyn R. Evans,
  • Holly L. Hedrick,
  • Karna Murthy,
  • Anthony Piazza,
  • Gregory Sysyn,
  • Ashley Lucke,
  • Molly Pont,
  • Allison Black,
  • Carl Coghill,
  • Anne Hansen,
  • Eugenia Pallotto,
  • Karna Murthy,
  • Gustave Falciglia,
  • Beth Haberman,
  • Tetyana Nesterenko,
  • Thomas Bartman,
  • Sushmita Yallapragada,
  • Lina Chalak,
  • Danielle Smith,
  • Stephanie Bourque,
  • Girija Natarjan,
  • Annie Chi,
  • Yvette Johnson,
  • Annmarie Gotiolo,
  • Lakshmi Katarkan,
  • Kristina Reber,
  • Rebecca Rose,
  • Julie Lindower,
  • Julie Weiner,
  • Laura Carroll,
  • Rachel Chapman,
  • Nina Menda,
  • Mark Weems,
  • Ann Downey,
  • Joanne Lagatta,
  • Priscilla Joe,
  • Trent Tipple,
  • Patricia Williams,
  • Nicole Birge,
  • Michel Mikhael,
  • Narendra Dereddy,
  • Rajan Wadhawan,
  • Aaron Weiss,
  • Michael Padula,
  • Vilarmis Quinones,
  • Pam Griffiths,
  • Toby Yanowitz,
  • Ellen Bendel-Stenzel,
  • Con Yee Ling,
  • Mark Speziale,
  • Robert DiGeronimo,
  • Elizabeth Jacobsen,
  • Beverly Brozanski,
  • Rakesh Rao,
  • Ann Downey,
  • Linda Van Marter,
  • Kyong-Soon Lee,
  • Billie Lou Short,
  • Kevin Sullivan,
  • Cherrie Welch

摘要

Background

This study examined inter-center variation (ICV) in inpatient outcomes for infants with congenital diaphragmatic hernia (CDH), aiming to contribute to quality metrics and clinical benchmarks in neonatal care.

Methods

We retrospectively analyzed CDH cases from the Children’s Hospitals Neonatal Consortium (CHNC) database (2010–2022), focusing on infants without prior surgical repair or discharge. Our outcomes of interest included inpatient survival, survival without ECMO, and hospital length of stay (LOS). We incorporated centers with ≥30 cases into multivariable models to adjust for patient and clinical factors.

Results

Analysis of 3639 infants revealed significant ICV. Unadjusted inpatient survival rate was 76.5%, with ICV ranging from 55.4% to 90.7%. The composite outcome of survival without ECMO was 63.3% (ICV: 38.6–87.9%). The median LOS for survivors was 50 days (ICV: 29–68 days). Multivariable analyses confirmed these trends, indicating an 18-fold variation in survival, a 35-fold variation in survival without ECMO, and a 3.3-fold variation in LOS across centers (p < 0.001 for all).

Conclusion

The treating center was a significant predictor of risk-adjusted inpatient outcomes for infants with CDH. These findings highlight substantial disparities in care and support the integration of these metrics into future research and quality improvement efforts in level IV NICUs.

Impact statement

This study reveals considerable inter-center differences in CDH outcomes, contributing extensive, multicenter data to the existing body of literature. It underscores how center-specific practices affect survival and ECMO use, suggesting that organized high-level care could enhance outcomes for CDH patients. These insights lay the groundwork for center-specific quality improvement initiatives to elevate the standard of care.