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.

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.