title: Case Volume and Outcomes of Congenital Diaphragmatic Hernia Surgery in Academic Medical Centers.
abstract: OBJECTIVE
  The outcome of patients with congenital diaphragmatic hernia (CDH) has not improved in the last decade and surgical repair remains the mainstay of treatment. The purpose of the present study was to assess whether a volume-outcome relationship exists in the U.S. academic medical centers performing surgical repair of neonatal CDH.
  
  
  METHODS
  A retrospective cross-sectional analysis of discharge data for neonates undergoing CDH repair in academic medical center members of the University Health-System Consortium was employed. Unadjusted mortality was compared between lower and higher surgical volume centers. A binary logistic regression model was fit to test the relationship of surgical volume with mortality.
  
  
  RESULTS
  A total of 3,738 patients underwent surgical repair in 122 unique academic medical centers in the United States. The overall rate of survival was 75.2%. There was no difference in unadjusted mortality between lower and higher volume centers. After controlling for patient and hospital variables, there was no difference in the odds of mortality between lower and higher volume centers (odds ratio 1.03 [95% confidence interval, 0.86-1.23, p = 0.730]).
  
  
  CONCLUSIONS
  Neonates born with congenital diaphragmatic hernia can undergo surgical repair in the U.S. academic medical centers independent of center procedure volume and expect good surgical outcomes.
authors.affiliation: Department of Pediatrics, Rush University Medical Center, Chicago, Illinois.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Kane
authors.affiliation: Health Systems Management, Rush University Medical Center, Chicago, Illinois.
authors.forename: Jake
authors.initials: J
authors.lastname: Harbert
authors.affiliation: Health Systems Management, Rush University Medical Center, Chicago, Illinois.
authors.forename: Samuel
authors.initials: S
authors.lastname: Hohmann
authors.affiliation: Department of Pediatric Surgery, Rush University Medical Center, Chicago, Illinois.
authors.forename: Srikumar
authors.initials: S
authors.lastname: Pillai
authors.affiliation: Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois.
authors.forename: Rajneesh
authors.initials: R
authors.lastname: Behal
authors.affiliation: Department of Pediatrics, Rush University Medical Center, Chicago, Illinois.
authors.forename: Debra
authors.initials: D
authors.lastname: Selip
authors.affiliation: Health Systems Management, Rush University Medical Center, Chicago, Illinois.
authors.forename: Tricia
authors.initials: T
authors.lastname: Johnson
mesh_terms: D000046:Academic Medical Centers; D003430:Cross-Sectional Studies; D005260:Female; D065630:Hernias, Diaphragmatic, Congenital / Q000401:mortality* / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology