Abstract：
BACKGROUND: 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.
METHODS: Retrospective Prognosis Study.
METHODS: Level II.
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.
METHODS: Retrospective Prognosis Study.
METHODS: Level II.
摘要：
背景：先天性膈疝（CDH）是一种危及生命的疾病，产前诊断的先天性异常。我们旨在描述德克萨斯州CDH婴儿的护理和结局以及治疗设施对护理量的影响。
方法：使用全州住院患者出院公共使用数据文件进行了回顾性队列研究（2013-2021）。使用CDHICD-9/ICD-10编码纳入<1岁的新生儿和婴儿。被转移到外部医院的新生儿被排除在外，以避免重复计算。描述性统计，进行卡方和logistic回归分析。
结果：在确定的1314例CDH患者中，728(55%)发生在5个较高体积的中心(HVC，>75例)，9个中量中心的326个（25%）（MVC，20-75例)和268例(20%)在79个低容量中心(LVC，<20例)。HVC的死亡率较低（18%，MVC22％vsLVC27％；p=0.011）尽管治疗了病情较重的患者（极端疾病严重程度：HVC71％，MVC62%对LVC50%；p<0.001），住院时间更长（p<0.001）。在136（10％）中使用了体外膜氧合，主要在HVC中提供。LVC治疗比例更多的非白人西班牙裔患者（p<0.001）和来自墨西哥边境各县的患者（p<0.001）。CDH患者死亡率的预测概率随着治疗设施CDH病例量的增加而降低，每增加一例CDH病例的死亡率下降0.5%(p<0.001)。
结论：接受HVC治疗的患者尽管严重程度增加，但死亡率明显降低。我们的数据表明，少数群体在LVC中的治疗可能不成比例，结果较差。
方法：回顾性预后研究。
方法：二级。
方法：使用全州住院患者出院公共使用数据文件进行了回顾性队列研究（2013-2021）。使用CDHICD-9/ICD-10编码纳入<1岁的新生儿和婴儿。被转移到外部医院的新生儿被排除在外，以避免重复计算。描述性统计，进行卡方和logistic回归分析。
结果：在确定的1314例CDH患者中，728(55%)发生在5个较高体积的中心(HVC，>75例)，9个中量中心的326个（25%）（MVC，20-75例)和268例(20%)在79个低容量中心(LVC，<20例)。HVC的死亡率较低（18%，MVC22％vsLVC27％；p=0.011）尽管治疗了病情较重的患者（极端疾病严重程度：HVC71％，MVC62%对LVC50%；p<0.001），住院时间更长（p<0.001）。在136（10％）中使用了体外膜氧合，主要在HVC中提供。LVC治疗比例更多的非白人西班牙裔患者（p<0.001）和来自墨西哥边境各县的患者（p<0.001）。CDH患者死亡率的预测概率随着治疗设施CDH病例量的增加而降低，每增加一例CDH病例的死亡率下降0.5%(p<0.001)。
结论：接受HVC治疗的患者尽管严重程度增加，但死亡率明显降低。我们的数据表明，少数群体在LVC中的治疗可能不成比例，结果较差。
方法：回顾性预后研究。
方法：二级。
