CAPS Original PapersEffect of hospital case volume on outcome in congenital diaphragmatic hernia: the experience of the Canadian Pediatric Surgery Network
Section snippets
Study population
Congenital diaphragmatic hernia cases were accrued between May 1, 2005, and January 1, 2008, at 13 CAPSNet centers. Cases were identified at prenatal diagnosis (if one was made) or after birth, and data were abstracted from diagnosis to death or discharge from the CAPSNet center.
The purpose of CAPSNet and its process of case ascertainment and data abstraction have been described previously [11]. Briefly, on-site trained research assistants abstract data from maternal and infant charts using a
Results
One hundred twenty-one CDH cases were entered into the database from the 13 contributing CAPSNet sites (Table 1). Of the 121 cases in the database, 98 survived to hospital discharge for an actual survival rate of 81% across all centers.
The median number of cases per site was 6. Six centers were identified as having greater than 6 CDH patient admissions (range, 7-36; n = 97 patients), entered in the database during the 31-month study period, and these hospitals were classified as HVC. The
Discussion
Multiple studies have been published on survival rates for infants with CDH demonstrating significant variability among centers [1], [2], [3], [4], [5], [6], [7], [8], [9], [10]. Improvements in preoperative stabilization, including the establishment of physiologic goal-directed ventilatory and cardiovascular treatment algorithms that address pulmonary hypoplasia and pulmonary hypertension while minimizing iatrogenic injury, have allowed some tertiary pediatric centers to report survival rates
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Presented at the 40th Annual CAPS Meeting, August 21-24, 2008, Toronto, Ontario, Canada.