Effect of hospital volume on the mortality of congenital diaphragmatic hernia in Japan
Article first published online: 16 APR 2013
© 2013 The Authors. Pediatrics International © 2013 Japan Pediatric Society
Volume 55, Issue 2, pages 190–196, April 2013
How to Cite
Hayakawa, M., Ito, M., Hattori, T., Kanamori, Y., Okuyama, H., Inamura, N., Takahashi, S., Nagata, K., Taguchi, T., Usui, N. and The Japanese Congenital Diaphragmatic Hernia Study Group (2013), Effect of hospital volume on the mortality of congenital diaphragmatic hernia in Japan. Pediatrics International, 55: 190–196. doi: 10.1111/ped.12059
- Issue published online: 16 APR 2013
- Article first published online: 16 APR 2013
- Accepted manuscript online: 30 JAN 2013 05:10AM EST
- Manuscript Accepted: 7 JAN 2013
- Manuscript Revised: 25 NOV 2012
- Manuscript Received: 19 JUN 2012
- the Ministry of Health, Labor and Welfare of Japan
- congenital diaphragmatic hernia;
- nationwide survey;
- prenatal diagnosis
During the last decade, new supportive modalities and new therapeutic strategies to treat congenital diaphragmatic hernia (CDH) have been introduced. In Japan, the large number of hospitals prevents centralizing infants with CDH in tertiary centers. The aim of this study was to evaluate the correlations between the number of CDH patients, survival rates, and the current strategies employed to treat CDH at the individual hospitals.
Eighty-three hospitals with 674 CDH cases were analyzed using questionnaires. We classified the hospitals into three groups according to the number of CDH patients treated: Group 1 (G1; more than 21 patients), Group 2 (G2; 11–20 patients), and Group 3 (G3; fewer than 10 patients).
The median number of CDH patients in G1, G2, and G3 were 28, 14, and 4, respectively. The overall survival rate was 74.5%. When only the isolated CDH cases with a prenatal diagnosis were included, the overall survival rate was 79.3%. The survival rate of isolated CDH cases with a prenatal diagnosis was significantly higher in G1 than that in G2 or G3 (87.2% vs 75.2% vs 74.3%; P < 0.001). There were no differences in perinatal therapeutic strategies among the three groups.
We concluded that it might therefore be important to centralize infants with CDH, especially those with isolated CDH with a prenatal diagnosis, to tertiary centers in Japan in order to improve the survival rates.