PMID- 35193755
OWN - NLM
STAT- MEDLINE
DCOM- 20221018
LR  - 20221214
IS  - 1531-5037 (Electronic)
IS  - 0022-3468 (Linking)
VI  - 57
IP  - 11
DP  - 2022 Nov
TI  - Variation across centers in standardized mortality ratios for congenital 
      diaphragmatic hernia receiving extracorporeal life support.
PG  - 606-613
LID - S0022-3468(22)00087-2 [pii]
LID - 10.1016/j.jpedsurg.2022.01.022 [doi]
AB  - BACKGROUND: We sought to elucidate the degree of variation across centers by 
      calculating center-specific standardized mortality ratios (SMRs) for infants with 
      congenital diaphragmatic hernia (CDH) requiring extracorporeal life support 
      (ECLS). METHODS: The Extracorporeal Life Support Organization (ELSO) registry 
      data (2000-2019) were used to estimate SMRs. Center-specific SMRs and their 95% 
      confidence intervals (CIs) were used to identify centers with mortality as 
      significantly worse (SW), significantly better (SB), or not different (ND) 
      relative to the median standardized mortality rate. RESULTS: We identified 4,223 
      neonates with CDH from 109 centers. SMRs were risk-adjusted for pre-ECLS case-mix 
      (birthweight, sex, race, 5 min Apgar, blood gases, gestational age, hernia side, 
      prenatal diagnosis, pre-ECLS arrest, and comorbidities). Observed (unadjusted) 
      mortality rates across centers varied substantially (range: 14.3%-90.9%; 
      interquartile range [IQR]: 42.9%-62.1%). Thirteen centers (11.9%) had SB SMRs< 1 
      (SMR 0.52 to 0.84), 7 centers (6.4%) had SW SMRs>1 (SMR 1.25 to 1.43), and 89 
      centers (81.7%) had SMRs ND relative to the median SMR rate across all centers 
      (i.e., SMR not different from one). Descriptive analyses demonstrated that SB 
      centers had a lower proportion of cases with renal complications, infectious 
      complications and discontinuation of ECLS owing to complications, as well as 
      differences in pre-ECLS treatments and timing of CDH repair, compared to SW and 
      ND centers. CONCLUSION: This study specifically identified ECLS centers with 
      higher and lower survival for patients with CDH, which may serve as a benchmark 
      for institutional quality improvement. Future studies are needed to identify 
      those specific processes at those centers that leads to favorable outcomes with 
      the goal of improving care globally. LEVEL OF EVIDENCE: Level III.
CI  - Copyright (c) 2022. Published by Elsevier Inc.
FAU - Guner, Yigit S
AU  - Guner YS
AD  - Division of Pediatric Surgery, Children's Hospital of Orange County, Orange, CA, 
      United States; Department of Surgery, University of California Irvine Medical 
      Center, Orange, CA, United States. Electronic address: yguner@hs.uci.edu.
FAU - Harting, Matthew T
AU  - Harting MT
AD  - Department of Pediatric Surgery, McGovern Medical School, Children's Memorial 
      Hermann Hospital, University of Texas, Houston, TX, United States.
FAU - Jancelewicz, Tim
AU  - Jancelewicz T
AD  - Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of 
      Tennessee Health Science Center, Memphis, TN, United States.
FAU - Yu, Peter T
AU  - Yu PT
AD  - Division of Pediatric Surgery, Children's Hospital of Orange County, Orange, CA, 
      United States; Department of Surgery, University of California Irvine Medical 
      Center, Orange, CA, United States.
FAU - Di Nardo, Matteo
AU  - Di Nardo M
AD  - Pediatric Intensive Care Unit, Bambino Gesu Children's Hospital, IRCCS, Rome, 
      Italy.
FAU - Nguyen, Danh V
AU  - Nguyen DV
AD  - Department of Medicine, University of California Irvine, Irvine, CA, United 
      States.
LA  - eng
PT  - Journal Article
DEP - 20220131
PL  - United States
TA  - J Pediatr Surg
JT  - Journal of pediatric surgery
JID - 0052631
RN  - 0 (Gases)
SB  - IM
MH  - *Extracorporeal Membrane Oxygenation
MH  - Female
MH  - Gases
MH  - *Hernias, Diaphragmatic, Congenital/surgery
MH  - Herniorrhaphy
MH  - Humans
MH  - Infant
MH  - Infant, Newborn
MH  - Registries
MH  - Retrospective Studies
MH  - Survival Rate
OTO - NOTNLM
OT  - CDH
OT  - ECLS
OT  - ECMO
OT  - Quality
OT  - SMR
EDAT- 2022/02/24 06:00
MHDA- 2022/10/19 06:00
CRDT- 2022/02/23 05:30
PHST- 2021/11/05 00:00 [received]
PHST- 2022/01/13 00:00 [revised]
PHST- 2022/01/20 00:00 [accepted]
PHST- 2022/02/24 06:00 [pubmed]
PHST- 2022/10/19 06:00 [medline]
PHST- 2022/02/23 05:30 [entrez]
AID - S0022-3468(22)00087-2 [pii]
AID - 10.1016/j.jpedsurg.2022.01.022 [doi]
PST - ppublish
SO  - J Pediatr Surg. 2022 Nov;57(11):606-613. doi: 10.1016/j.jpedsurg.2022.01.022. 
      Epub 2022 Jan 31.