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Hospital volume and outcome in the treatment of congenital diaphragmatic hernia in Germany: observational study using national hospital discharge data from 2016 to 2023

Background - Congenital diaphragmatic hernia (CDH) is a critical malformation, with the neonatal period being particularly challenging and associated with high mortality. Data on the care structure and volume-outcome relationship in the treatment of children with CDH in Germany remain scarce. - Meth...

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Main Authors: Elrod, Julia (Author) , Boettcher, Michael (Author) , Kipfmüller, Florian (Author) , Schaible, Thomas (Author) , Wolfram Trudo, Knoefel (Author) , Mohr, Christoph (Author) , Herwig, Ramona (Author) , Samans, Max (Author) , Busse, Reinhard (Author) , Nimptsch, Ulrike (Author) , Wilms, Miriam (Author)
Format: Article (Journal)
Language:English
Published: September 2025
In: Journal of pediatric surgery
Year: 2025, Volume: 60, Issue: 9, Pages: 1-10
ISSN:1531-5037
DOI:10.1016/j.jpedsurg.2025.162399
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1016/j.jpedsurg.2025.162399
Verlag, kostenfrei, Volltext: https://www.sciencedirect.com/science/article/pii/S0022346825002441
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Author Notes:Julia Elrod, Michael Boettcher, Florian Kipfmueller, Thomas Schaible, Knoefel Wolfram Trudo, Christoph Mohr, Ramona Herwig, Max Samans, Reinhard Busse, Ulrike Nimptsch, Miriam Wilms
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Summary:Background - Congenital diaphragmatic hernia (CDH) is a critical malformation, with the neonatal period being particularly challenging and associated with high mortality. Data on the care structure and volume-outcome relationship in the treatment of children with CDH in Germany remain scarce. - Methods - This study determined case numbers and outcomes of treatment of children aged 0-17 years, with CDH in Germany between 2016 and 2023 through a query of the nationwide DRG database at the Research Data Center of the Federal Statistical Office. Using the ICD-10 and OPS codes, inpatient cases with and without ECMO treatment were identified. The analysis included patient characteristics, hospital caseload, treatment characteristics and outcome parameters stratified by hospital caseload. - Results - In the 8 years, a total of 1470 newborns with CDH were born across 234 different hospitals, with a median annual caseload of 1 (IQR: 1-2). In-hospital mortality was 22.5 %. Corrective surgery was performed in 1539 cases across 103 hospitals. Mortality among patients who underwent corrective surgery was 4.8 % in low-volume centers, 5.3 % in medium-volume centers, and 9.6 % in high-volume centers. A higher ECMO frequency was observed in high-volume centers (32.2 % vs. 5.4 % in medium-volume and 1.9 % in low-volume). Among all ECMO-treated CDH patients, regardless of corrective surgery, mortality was 60.0 %, 40.0 %, and 36.5 % in low-, medium-, and high-volume centers, respectively. - Conclusions - These findings indicate that high-volume centers treat a greater proportion of severe cases and that they may achieve better outcomes for the most critically ill patients, as reflected by lower ECMO-specific mortality.
Item Description:Online verfügbar: 7. Juni 2025, Artikelversion: 18. Juni 2025
Gesehen am 19.08.2025
Physical Description:Online Resource
ISSN:1531-5037
DOI:10.1016/j.jpedsurg.2025.162399

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