Inter-center variation in death or tracheostomy placement in infants with severe bronchopulmonary dysplasia.
To estimate the presence and sources of inter-center variation (ICV) in the risk of death or tracheostomy placement (D/T) among infants with severe bronchopulmonary dysplasia (sBPD)Study design:We analyzed the Children's Hospitals Neonatal Database between 2010 and 2013 to identify referred infants born <32 weeks' gestation with sBPD. The association between center and the primary outcome of D/T was analyzed by multivariable modeling. Hypothesized diagnoses/practices were included to determine if these explained any observed ICV in D/T.



D/T occurred in 280 (20%) of 1383 eligible infants from 21 centers. ICV was significant for D/T (range 2-46% by center, P<0.001) and tracheostomy placement (n=187, range 2-37%, P<0.001), but not death (n=93, range 0-19%, P=0.08). This association persisted in multivariable analysis (adjusted center-specific odds ratios for D/T varied 5.5-fold, P=0.009).



ICV in D/T is apparent among infants with sBPD. These results highlight that the indications for tracheostomy (and subsequent chronic ventilation) remain uncertain.
Department of Pediatrics, Feinberg School of Medicine, Northwestern University and The Ann &Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
K
K
Murthy
Department of Pediatrics, Feinberg School of Medicine, Northwestern University and The Ann &Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
N F M
NFM
Porta
Department of Pediatrics, Medical College of Wisconsin and The Children's Hospital of Wisconsin, Milwaukee, WI, USA.
J M
JM
Lagatta
Department of Analytics, Children's Hospital Association, Inc, Overland Park, KS &Department of Statistics, University of Missouri, Columbia, MO, USA.
I
I
Zaniletti
Department of Pediatrics, University of Missouri Kansas City School of Medicine and The Center for Infant Pulmonary Disorders, Children's Mercy Hospitals &Clinics, Kansas City, MO, USA.
W E
WE
Truog
Department of Pediatrics, University of Colorado School of Medicine and The Colorado Children's Hospital, Aurora, CO, USA.
T R
TR
Grover
Department of Pediatrics and Center for Perinatal Research, The Ohio State University College of Medicine and The Nationwide Children's Hospital, Columbus, OH, USA.
L D
LD
Nelin
Department of Pediatrics, University of Texas Southwestern Medical Center and the Children's Medical Center of Dallas, Dallas, TX, USA.
R C
RC
Savani
D001997:Bronchopulmonary Dysplasia / Q000401:mortality* / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D008297:Male; D015999:Multivariate Analysis; D012720:Severity of Illness Index; D014139:Tracheostomy / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology