ECMO hospital volume and survival in congenital diaphragmatic hernia repair.
OBJECTIVE
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.
Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida 33136, USA.
James S
JS
Davis
Mark L
ML
Ryan
Eduardo A
EA
Perez
Holly L
HL
Neville
Steven N
SN
Bronson
Juan E
JE
Sola
D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006548:Hernia, Diaphragmatic / Q000401:mortality / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D016015:Logistic Models; D008297:Male; D015996:Survival Rate