318 - Inter-center Variations in Inpatient Outcomes for Infants with Congenital Diaphragmatic Hernia (CDH) from the Children’s Hospitals Neonatal Consortium

Poster Number: 318
Publication Number: 318.1128

Background: Congenital diaphragmatic hernia (CDH) confers risks of mortality, extracorporeal support (ECMO), and prolonged hospitalization in the neonatal intensive care unit (NICU). How these outcomes vary among centers of care remains uncertain particularly when accounting for markers of illness severity.

Objective: To estimate the inter-center variation (ICV) in survival, survival without receiving ECMO, and hospital length of stay (LOS) for infants with CDH

Design/Methods: The Children’s Hospitals Neonatal Consortium’s (CHNC) database was used to identify infants with CDH from 2010-2022. Infants with surgical repair or hospital discharge prior to their first NICU admission were omitted. The main outcomes were (1) inpatient survival, (2) survival without receiving ECMO, and (3) hospital LOS in survivors. The main exposure was center, and those with < 30 cases were omitted. Patient, clinical, and diagnostic factors that were significant in univariable analyses (p < 0.2) were tested in multivariable logistic regression (survival, survival without receiving ECMO) equations and generalized linear models with log link for gamma-distributed outcomes (LOS).

Results: For 3639 infants with CDH, the unadjusted inpatient survival (76.5% [ICV 55.4, 90.7%]), survival without receiving ECMO (63.3% [ICV 38.6, 87.9%]), and LOS (median 50 days [ICV 29, 68 days]) varied across the 38 centers. These unadjusted associations persisted in multivariable analyses: risk-adjusted survival across centers varied 18-fold, survival without receiving ECMO varied 35-fold, and hospital LOS in survivors varied 3.3-fold (p < 0.001 for all) in these equations (Table). Model performance was high for each outcome (area under receiver operating characteristic curve > 0.86). Secondarily, unadjusted rates of ECMO use (26% [ICV 2.2, 50%], p< 0.001) and gastrostomy insertion (16.4% [ICV 5.8, 37%, p< 0.001]) exhibited ICV. Rates of survival after ECMO (50.2%, p=0.17) and rates of tracheostomy (4.0%, p=0.7) did not. Lastly, center-specific rates of survival and the median LOS among surviving infants at those centers were unrelated (p=0.89).

Conclusion(s): Center of care was independently associated with inpatient, risk-adjusted outcomes for infants with CDH. These estimations may inform disease-specific outcomes in regional, level IV NICUs and merit further investigation for use (as metrics) in future observational research and quality improvement initiatives.