ECMO hospital volume and survival in congenital diaphragmatic hernia repair

James S. Davis, Mark L. Ryan, Eduardo A. Perez, Holly L. Neville, Steven N. Bronson, Juan E. Sola

Research output: Contribution to journalArticle

26 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)791-796
Number of pages6
JournalJournal of Surgical Research
Volume178
Issue number2
DOIs
StatePublished - Dec 1 2012

Keywords

  • Congenital diaphragmatic hernia
  • ECMO
  • KID
  • Outcomes
  • Population-based study

ASJC Scopus subject areas

  • Surgery

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